Data from Postmarketing Studies Indicate that Shunting-Associated Hypoxemia Occurs in <1% of Nicardipine-Treated Patients
Case Report in a Patient Post-Lung Transplant (Ann Am Thorac Soc, 2016) [MEDLINE]
Authors Postulated that Effect was Related to Nicardipine Inhibition of Hypoxic Pulmonary Vasoconstriction, Resulting in V/Q Mismatch and/or Shunt (Br J Anaesth, 1988) [MEDLINE]
Physiology
Possible Ventilation/Perfusion (V/Q) Mismatch and/or Pulmonary Shunt
In Small Studies of Abdominal Aortic Surgery Patients, Nicardipine Has Been Demonstrated to Increase V/Q Mismatch (J Cardiothorac Vasc Anesth, 1997) [MEDLINE]
Nicardipine Decreased the pO2 from 85.0 +/- 12.1 mmHg to 70.3 +/- 9.2 mmHg (p < 0.001), Associated with an Increase in Venous Admixture from 21.7% +/- 3.2% to 28.0% +/- 5.2% (p < 0.01)
Oxygen Delivery Increased Moderately
Oxygen Extraction Decreased
Oxygen Consumption was Unchanged
Other Adverse Effects
<1%, postmarketing, and/or case reports
Abnormal dreams, abnormal hepatic function tests, abnormal vision, angina pectoris, anxiety, arthralgia, atrial fibrillation (not distinguishable from natural history of atherosclerotic vascular disease), atrioventricular block, atypical chest pain, blurred vision, cerebral ischemia (not distinguishable from natural history of atherosclerotic vascular disease), confusion, conjunctivitis, constipation, deep vein thrombophlebitis, depression, depression of ST segment on ECG, dyspnea, ear disease, ECG abnormal, fever, gingival hyperplasia, heart block (not distinguishable from natural history of atherosclerotic vascular disease), hot flash, hyperkinesia, hypersensitivity reaction, hypertonia, hypophosphatemia, impotence, infection, insomnia, inversion T wave on ECG, malaise, myocardial infarction (chronic therapy; may be due to disease progression), neck pain, nervousness, nocturia, orthostatic hypotension, parotitis, pericarditis (not distinguishable from natural history of atherosclerotic vascular disease), peripheral vascular disease, psoriasis (Song 2021), respiratory tract disease, rhinitis, sinus node dysfunction (chronic therapy; may be due to disease progression), sinusitis, sore throat, sustained tachycardia, syncope, thrombocytopenia, tinnitus, tremor, urinary frequency, ventricular extrasystoles, ventricular tachycardia, vertigo, vomiting
Effect of nicardipine hydrochloride on regional hypoxic pulmonary vasoconstriction. Br J Anaesth. 1988 Apr;60(5):547-54. doi: 10.1093/bja/60.5.547 [MEDLINE]
Adverse Effects
Intravenous nicardipine in the treatment of postoperative arterial hypertension. J Cardiothorac Vasc Anesth. 1997 Apr;11(2):160-4. doi: 10.1016/s1053-0770(97)90206-8 [MEDLINE]
Pulmonary edema induced by calcium-channel blockade for tocolysis. Anesth Analg. 2004 Sep;99(3):910-911. doi: 10.1213/01.ANE.0000135182.79774.A0 [MEDLINE]
[Acute pulmonary edema during preterm labor: role of nicardipine tocolysis (three cases)]. J Gynecol Obstet Biol Reprod (Paris). 2005 Dec;34(8):807-12. doi: 10.1016/s0368-2315(05)82958-8 [MEDLINE]
Nicardipine-induced acute pulmonary edema: a rare but severe complication of tocolysis. Case Rep Crit Care. 2014;2014:242703. doi: 10.1155/2014/242703 [MEDLINE]
Nicardipine-associated pulmonary edema in a parturient: use of chest ultrasound. Int J Obstet Anesth. 2014 Aug;23(3):291-2. doi: 10.1016/j.ijoa.2014.04.009 [MEDLINE]
Severe, Rapidly Reversible Hypoxemia in the Early Period after Bilateral Lung Transplantation. Ann Am Thorac Soc. 2016 Jun;13(6):979-85. doi: 10.1513/AnnalsATS.201602-107CC [MEDLINE]