Cardene I.V. Mechanism Of Action

Arteriolar-specific control with a well-documented safety profile

A pure afterload reducer¹... decreases systemic vascular resistance²

Hemodynamic studies demonstrate significant increases in ejection fraction and cardiac output¹

Hemodynamic equation^3-5

More selective to vascular smooth muscle than cardiac muscle¹

The relative effects are ranked from no effect (0) to most prominent (+++++).

*	AV = atrioventricular.

†	Caution should be exercised when using CARDENE I.V., particularly in combination with a ß-blocker in patients with CHF or significant left ventricular dysfunction. In vitro and in some patients, a negative inotropic effect has been observed.

Increased systemic vascular resistance is a primary component of acute hypertension¹⁰

Potent arteriolar dilator not associated with venous dilation¹

*Enalaprilat, fenoldopam, and phentolamine are not commonly used.

Important Safety Information

Close monitoring of the blood pressure is required during therapy. CARDENE I.V. is contraindicated in patients with known hypersensitivity to the drug and in patients with advanced aortic stenosis. Reduction of diastolic pressure and reduced afterload may worsen rather than improve myocardial oxygen balance. Caution is advised when administering CARDENE I.V. to patients with impaired renal or hepatic function, in combination with a beta-blocker in patients with congestive heart failure, or portal hypertension. Observe caution in patients with significant left ventricular dysfunction due to possible negative inotropic effect. CARDENE I.V. gives no protection against the dangers of abrupt beta-blocker withdrawal; beta-blocker dosage should be gradually reduced. Levels of cyclosporine should be closely monitored during therapy. The most common side effects of CARDENE I.V. are headache (14.6%), hypotension (5.6%), nausea/vomiting (4.9%), and tachycardia (3.5%). Less frequent adverse effects, in each case occurring at 1.4%, include ECG abnormalities, postural hypotension, ventricular extrasystoles, injection-site reaction, dizziness, sweating and polyuria.

Please see full prescribing information.

	References
	1.	CARDENE I.V. [prescribing information]. Bedminster, NJ: EKR Therapeutics, Inc; 2008.
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	4.	Davidson CJ, Bonow R. Cardiac catheterization. In: Zipes D, Libby P, Bonow R, Braunwald E, eds. Braunwald's Heart Disease: a Textbook of Cardiovascular Medicine. 7th ed. Philadelphia, Pa: Elsevier Saunders; 2005;1:395-422.
	5.	Kaplan NM. Systemic hypertension: mechanisms and diagnosis. In: Zipes D, Libby P, Bonow R, Braunwald E, eds. Braunwald's Heart Disease: a Textbook of Cardiovascular Medicine. 7th ed. Philadelphia, Pa: Elsevier Saunders; 2005;1:959-987.
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	7.	Rose JC, Mayer SA. Optimizing blood pressure in neurological emergencies. Neurocrit Care. 2004;1:287-299.
	8.	Strandgaard S. Autoregulation of cerebral blood flow in hypertensive patients: the modifying influence of prolonged antihypertensive treatment on the tolerance to acute, drug-induced hypotension. Circulation. 1976;53:720-727.
	9.	Strandgaard S, Paulson OB. Cerebral blood flow and its pathophysiology in hypertension. Am J Hypertens. 1989;2:486-492.
	10.	Oates JA, Brown NJ. Antihypertensive agents and the drug therapy of hypertension. In: Hardman JG, Limbird LE, Gilman AG, eds. Goodman and Gilman's The Pharmacological Basis of Therapeutics. 10th ed. New York, NY: McGraw-Hill; 2001:871-900.