Nicardipine Hydrochloride

Nicardipine elevates plasma cyclosporine levels through inhibition of hepatic microsomal enzymes including CYP3A4. Cyclosporine plasma concentrations should be closely monitored and dosage reduced accordingly.

Severe hypotension has been reported during fentanyl anesthesia with concomitant use of beta-blockers and calcium channel blockers. An increased volume of circulating fluids might be required.

Nicardipine may elevate plasma tacrolimus levels through inhibition of hepatic microsomal enzymes including CYP3A4. Plasma concentrations should be closely monitored and dose adjusted accordingly.

Cimetidine increases nicardipine hydrochloride plasma levels. Patients receiving both drugs concomitantly should be carefully monitored.

Nicardipine hydrochloride usually does not alter plasma levels of digoxin; however, serum digoxin levels should be evaluated after initiating concomitant therapy.

7 DRUG INTERACTIONS 7.1 Antihypertensive Agents Since nicardipine hydrochloride injection may be administered to patients already being treated with other medications, including other antihypertensive agents, careful monitoring of these patients is necessary to detect and to treat promptly any undesired effects from concomitant administration. 7.2 Beta-Blockers In most patients, nicardipine hydrochloride injection can safely be used concomitantly with beta-blockers. However, monitor response carefully when combining nicardipine hydrochloride injection with a beta-blocker in the treatment of congestive heart failure patients [see Warnings and Precautions ( 5- 5.4)].

Beta-receptor blockers have been frequently administered concomitantly with nicardipine hydrochloride. The combination is well tolerated.

When therapeutic concentrations of furosemide, propranolol, dipyridamole, warfarin, quinidine or naproxen were added to human plasma (in vitro), the plasma protein binding of nicardipine hydrochloride capsules were not altered.

When therapeutic concentrations of furosemide, propranolol, dipyridamole, warfarin, quinidine or naproxen were added to human plasma (in vitro), the plasma protein binding of nicardipine hydrochloride capsules were not altered.