Nicardipine Hydrochloride (Page 4 of 5)

12.3 Pharmacokinetics

Distribution

A rapid dose-related increase in nicardipine plasma concentrations is seen during the first two hours after the start of an infusion of nicardipine. Plasma concentrations increase at a much slower rate after the first few hours, and approach steady state at 24 to 48 hours. The steady-state pharmacokinetics of nicardipine are similar in elderly hypertensive patients (greater than 65 years) and young healthy adults. On termination of the infusion, nicardipine concentrations decrease rapidly, with at least a 50% decrease during the first two hours post-infusion. The effects of nicardipine on blood pressure significantly correlate with plasma concentrations. Nicardipine is highly protein bound (greater than 95%) in human plasma over a wide concentration range.

Following infusion, nicardipine plasma concentrations decline triexponentially, with a rapid early distribution phase (α-half-life of 3 minutes), an intermediate phase (ß-half-life of 45 minutes), and a slow terminal phase (ƴ-half-life of 14 hours) that can only be detected after long-term infusions. Total plasma clearance (Cl) is 0.4 L/hr•kg, and the apparent volume of distribution (Vd) using a non-compartment model is 8.3 L/kg. The pharmacokinetics of nicardipine is linear over the dosage range of 0.5 mg/hr to 40 mg/hr.

Metabolism and Excretion

Nicardipine has been shown to be rapidly and extensively metabolized by the hepatic cytochrome P450 enzymes, CYP2C8, 2D6, and 3A4. Nicardipine does not induce or inhibit its own metabolism; however, nicardipine has been shown to inhibit certain cytochrome P450 enzymes (including CYP3A4, CYP2D6, CYP2C8, and CYP2C19). Inhibition of these enzymes may result in increased plasma levels of certain drugs, including cyclosporine and tacrolimus [ see Drug Interactions ( 7.5, 7.6)]. The altered pharmacokinetics may necessitate dosage adjustment of the affected drug or discontinuation of treatment.

After coadministration of a radioactive intravenous dose of nicardipine with an oral 30 mg dose given every 8 hours, 49% of the radioactivity was recovered in the urine and 43% in the feces within 96 hours. None of the dose was recovered as unchanged nicardipine.

13 NONCLINICAL TOXICOLOGY

13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility

Rats treated with nicardipine in the diet (at concentrations calculated to provide daily dosage levels of 5, 15, or 45 mg/kg/day) for two years showed a dose-dependent increase in thyroid hyperplasia and neoplasia (follicular adenoma/carcinoma). One-month and three-month studies in the rat have suggested that these results are linked to a nicardipine-induced reduction in plasma thyroxine (T4) levels with a consequent increase in plasma levels of thyroid stimulating hormone (TSH). Chronic elevation of TSH is known to cause hyperstimulation of the thyroid.

In rats on an iodine deficient diet, nicardipine administration for one month was associated with thyroid hyperplasia that was prevented by T4 supplementation.

Mice treated with nicardipine in the diet (at concentrations calculated to provide daily dosage levels of up to 100 mg/kg/day) for up to 18 months showed no evidence of neoplasia of any tissue and no evidence of thyroid changes.

There was no evidence of thyroid pathology in dogs treated with up to 25 mg nicardipine/kg/day for one year and no evidence of effects of nicardipine on thyroid function (plasma T4 and TSH) in man.

There was no evidence of a mutagenic potential of nicardipine in a battery of genotoxicity tests conducted on microbial indicator organisms, in micronucleus tests in mice and hamsters, or in a sister chromatid exchange study in hamsters.

No impairment of fertility was seen in male or female rats administered nicardipine at oral doses as high as 100 mg/kg/day (human equivalent dose about 16 mg/kg/day, 8 times the maximum recommended human oral dose).

13.3 Reproductive and Developmental Toxicology

Embryolethality, but no teratogenicity, was seen at intravenous doses of 10 mg nicardipine/kg/day in rats and 1 mg/kg/day in rabbits. These doses in the rat and rabbit are equivalent to human intravenous doses of about 1.6 and 0.32 mg/kg/day, respectively. (The total daily human dose delivered by a continuous intravenous infusion ranges from 1.2 to 6 mg/kg/day, depending on duration at different infusion rates ranging from 3 mg/hr to 15 mg/hr as individual patients are titrated for optimal results.) Nicardipine was also embryocidal when administered orally to pregnant Japanese White rabbits, during organogenesis, at 150 mg/kg/day (a dose associated with marked body weight gain suppression in the treated doe), but not at 50 mg/kg/day (human equivalent dose about 16 mg/kg/day or about 8 times the maximum recommended human oral dose). No adverse effects on the fetus were observed when New Zealand albino rabbits were treated orally, during organogenesis, with up to 100 mg/kg/day (a dose associated with significant mortality in the treated doe). In pregnant rats administered nicardipine orally at doses of up to 100 mg/kg/day (human equivalent dose about 16 mg/kg/day) there was no evidence of embryolethality or teratogenicity. However, dystocia, reduced birth weight, reduced neonatal survival and reduced neonatal weight gain were noted.

14 CLINICAL STUDIES

Effects in Hypertension

In patients with mild-to-moderate chronic stable essential hypertension, nicardipine hydrochloride injection (0.5 mg/hr to 4 mg/hr) produced dose-dependent decreases in blood pressure, although only the decreases at 4 mg/hr were statistically different from placebo. At the end of a 48-hour infusion at 4 mg/hr, the decreases were 26 mmHg (17%) in systolic blood pressure and 21 mmHg (20%) in diastolic blood pressure. In other settings (e.g., patients with severe or postoperative hypertension), nicardipine hydrochloride injection (5 mg/hr to 15 mg/hr) produced dose-dependent decreases in blood pressure. Higher infusion rates produced therapeutic responses more rapidly. The mean time to therapeutic response for severe hypertension, defined as diastolic blood pressure less than or equal to 95 mmHg or greater or equal to 25 mmHg decrease and systolic blood pressure less than or equal to 160 mmHg, was 77 ± 5 minutes. The average maintenance dose was 8.0 mg/hr. The mean time to therapeutic response for postoperative hypertension, defined as greater than or equal to 15% reduction in diastolic or systolic blood pressure, was 12 minutes. The average maintenance dose was 3 mg/hr.

16 HOW SUPPLIED / STORAGE AND HANDLING

16.1 How Supplied

Nicardipine Hydrochloride Injection is available in packages as follows:

NDC		Strength		Packaged
0143-9542-10		25 mg/10 mL Single Dose Vial (2.5 mg/mL)		10 vials of 10 mL

16.2 Storage and Handling

Store at 20° to 25°C (68° to 77°F) [See USP Controlled Room Temperature].

Freezing does not adversely affect the product, but exposure to elevated temperatures should be avoided. Protect from light. Store vials in carton until used.

PREMIERProRx®

Manufactured by:
EXELA PHARMA SCIENCES, LLC.
1245 Blowing Rock Blvd.
Lenoir, NC 28645

Distributed by:
Hikma Pharmaceuticals USA Inc.
Berkeley Heights, NJ 07922

PremierProRx® is a registered trademark of Premier, Inc., used under license.

Revised: July 2021

PRINCIPAL DISPLAY PANEL

NDC 0143-9542 -01 Rx only
Nicardipine
Hydrochloride Injection
25 mg per 10 mL
(2.5 mg/mL)
WARNING: MUST BE DILUTE D BEFORE INFUSION
Discard Unused Portion
For Intravenous use ONLY10 mL Single Dose Vial