Calcium-channel blockers
Nicardipine
A calcium-channel blocker that relaxes and widens blood vessels to lower blood pressure.
What is Nicardipine?
Nicardipine is a calcium-channel blocker of the dihydropyridine type, used mainly to lower high blood pressure and to help angina. It works by relaxing the muscle in artery walls so blood flows more easily. Common effects include flushing, headache and swollen ankles, and grapefruit should be avoided.
Education and reference only. This is a plain-language guide to Nicardipine — it deliberately contains no doses. Doses depend on the person, the brand and the reason for treatment, and belong with your prescriber. Always check the BNF, the product labelling (SmPC) and follow medical advice.
What it is
Nicardipine is a dihydropyridine calcium-channel blocker, in the same broad family as amlodipine and nifedipine. In the UK it is used to treat high blood pressure (hypertension) and to prevent the chest pain of angina. A short-acting injectable form is also used in hospital to control very high blood pressure quickly, given under close supervision.
How it works
Nicardipine blocks the channels that let calcium enter the muscle cells in the walls of arteries. With less calcium getting in, the muscle relaxes and the arteries widen. This lowers the pressure the heart has to pump against, reducing blood pressure, and it also improves blood flow to the heart muscle, which helps angina.
Company & origin
Originated / developed by: Originally developed by Yamanouchi (now Astellas); available as a generic medicine..
Developed in Japan in the 1970s as a dihydropyridine calcium-channel blocker and later used in the UK for high blood pressure and angina.
What it treats
Conditions Nicardipine is used for
Practical use
How to take Nicardipine
General, dose-free guidance — always follow your prescriber's and the leaflet's specific instructions.
- Take it regularly at the same times each day to keep blood pressure steady.
- Swallow capsules whole with a drink of water.
- Avoid grapefruit and grapefruit juice while taking it.
- Stand up slowly, particularly when you first start, to reduce dizziness.
- If a dose is missed, take it when you remember unless the next one is near, then skip it; never double up.
- Do not stop suddenly without advice, as this can unsettle your blood pressure or angina.
Weighing it up
Advantages & disadvantages of Nicardipine
Advantages
- Effectively lowers blood pressure and relieves angina by widening the arteries.
- Does not slow the heart rate in the way some other heart medicines do.
- A hospital injectable form allows rapid, controlled blood-pressure lowering when needed.
Disadvantages
- Vessel-widening effects such as flushing, headache and ankle swelling are common.
- Can cause a fast or pounding heartbeat as the body responds to lower blood pressure.
- Interacts with grapefruit and with several other medicines, and usually needs taking more than once a day.
Practical use
Good to know
Nicardipine widens blood vessels, so flushing, headache and swollen ankles are common, especially at the start. Stand up slowly at first, as it can cause dizziness. Avoid grapefruit and grapefruit juice, which can raise the amount of medicine in your blood. Tell your prescriber if you have heart or liver problems.
Who should not take it / use with caution
- People with very narrow heart valves (significant aortic stenosis) or unstable, severe heart problems.
- People who have recently had a heart attack or have advanced heart failure, without specialist advice.
- People with severe liver disease, who may need closer review.
Monitoring
- Blood pressure and pulse, particularly after starting or changing the dose.
- Ankle swelling and any new breathlessness.
- Liver function in people with liver problems.
Side effects
- Flushing, headache and a feeling of warmth.
- Swollen ankles or feet from fluid pooling.
- Dizziness, especially on standing, and a fast or pounding heartbeat.
- Tiredness, nausea or palpitations in some people.
Key interactions
- Grapefruit and grapefruit juice, which can raise levels of the medicine.
- Other blood-pressure-lowering medicines, which add to the effect.
- Some heart-rhythm medicines, certain antifungals and antibiotics, and ciclosporin.
Available as: Available as capsules, and as a solution for injection used in hospital.
Answers
Nicardipine: frequently asked questions
Why do my ankles swell on nicardipine?
Like other dihydropyridine calcium-channel blockers, it widens small blood vessels, which can let fluid collect in the ankles and feet. It is usually harmless but tell your prescriber if it is troublesome, as the medicine may need reviewing.
Can I drink grapefruit juice?
No. Grapefruit and its juice can raise the level of nicardipine in your blood and increase side effects, so it is best avoided while taking it.
Will it slow my heart rate?
Unlike some other calcium-channel blockers, nicardipine mainly relaxes blood vessels and does not slow the heart. In fact it can sometimes cause a faster heartbeat.
Can I stop taking it if I feel well?
Do not stop suddenly. High blood pressure rarely causes symptoms, so feeling well does not mean it has gone. Speak to your prescriber before making any changes.
Is the dizziness dangerous?
Mild dizziness is common at first as your blood pressure settles. Stand up slowly. Tell your prescriber if it is severe, persistent or causes falls.
The wider class
About Calcium-channel blockers
Nicardipine belongs to the calcium-channel blockers class. For how the class as a whole works, its shared safety principles and monitoring, see the full guide.
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Authoritative sources
- BNF
- NICE CKS
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