Curran Monique P, Robinson Dean M, Keating Gillian M
Adis International Limited, Auckland, New Zealand.
Drugs. 2006;66(13):1755-82. doi: 10.2165/00003495-200666130-00010.
Nicardipine is a water soluble calcium channel antagonist, with predominantly vasodilatory actions. Intravenous (IV) nicardipine (Cardene IV), which demonstrates a relatively rapid onset/offset of action, is used in situations requiring the rapid control of blood pressure (BP). IV nicardipine was as effective as IV nitroprusside in the short-term reduction of BP in patients with severe or postoperative hypertension. A potential role for IV nicardipine in the intraoperative acute control of BP in patients undergoing various surgical procedures (including cardiovascular, neurovascular and abdominal surgery), and in the deliberate induction of reduced BP in surgical procedures in which haemostasis may be difficult (e.g. surgery involving the hip or spine) was demonstrated in preliminary studies. Preliminary studies also indicated the ability of a bolus dose of IV nicardipine to attenuate the hypertensive response, but not the increase in tachycardia, after laryngoscopy and tracheal intubation in anaesthetised patients. In large, well designed studies, IV nicardipine prevented cerebral vasospasm in patients with recent aneurysmal subarachnoid haemorrhage; however, overall clinical outcomes at 3 months were similar to those in patients who received standard management. Small preliminary studies have investigated the use of IV nicardipine in a variety of other settings, including acute intracerebral haemorrhage, acute ischaemic stroke, pre-eclampsia, acute aortic dissection, premature labour and electroconvulsive therapy.In conclusion, the efficacy of IV nicardipine in the short-term treatment of hypertension in settings for which oral therapy is not feasible or not desirable is well established. The ability to titrate IV nicardipine to the tolerance levels of individual patients makes this agent an attractive option, especially in critically ill patients or those undergoing surgery. Potential exists for further investigation of the use of this agent in clinical settings where a vasodilatory agent with minimal inotropic effects is appropriate.
尼卡地平是一种水溶性钙通道拮抗剂，主要具有血管舒张作用。静脉注射尼卡地平（盐酸尼卡地平注射液）起效和失效相对较快，用于需要快速控制血压的情况。在重度或术后高血压患者中，静脉注射尼卡地平在短期内降低血压方面与静脉注射硝普钠效果相当。初步研究表明，静脉注射尼卡地平在接受各种外科手术（包括心血管、神经血管和腹部手术）的患者术中急性控制血压，以及在止血可能困难的外科手术（如涉及髋部或脊柱的手术）中有意诱导血压降低方面具有潜在作用。初步研究还表明，在麻醉患者中，静脉注射一剂尼卡地平能够减弱喉镜检查和气管插管后的高血压反应，但不能减弱心动过速的增加。在大型、设计良好的研究中，静脉注射尼卡地平可预防近期动脉瘤性蛛网膜下腔出血患者的脑血管痉挛；然而，3个月时的总体临床结局与接受标准治疗的患者相似。小型初步研究调查了静脉注射尼卡地平在多种其他情况下的应用，包括急性脑出血、急性缺血性中风、子痫前期、急性主动脉夹层、早产和电惊厥治疗。总之，静脉注射尼卡地平在口服治疗不可行或不理想的情况下用于高血压的短期治疗，其疗效已得到充分证实。能够将静脉注射尼卡地平滴定至个体患者的耐受水平，使该药物成为一个有吸引力的选择，尤其是在危重症患者或接受手术的患者中。在需要一种具有最小变力作用的血管舒张剂的临床环境中，对该药物的应用进行进一步研究具有潜力。
