Abstract
Nicardipine is a dihydropyridine-type Ca2+ channel blocker (CCB) with strong antihypertensive activity and with a peculiar cerebrovascular
profile. This paper has reviewed the main controlled clinical studies on nicardipine
in pathologies associated with cerebrovascular impairment. Subarachnoid haemorrhage
(SAH) is managed with CCBs to prevent vasospasm and improve clinical outcomes. Nimodipine
is the CCB licensed for this indication. Former studies did not demonstrate an advantage
of nicardipine versus nimodipine in SAH. A more recent approach administering the
drug intra-arterially or using implants of nicardipine prolonged-release showed a
decreased incidence of vasospasm, delayed ischemic deficits and improved clinical
outcome after severe SAH. Nicardipine is recommended for elevated blood pressure after
acute ischemic stroke or intracerebral haemorrhage and is effective in prevention
of stroke. More recent investigations were focused on the treatment of cognitive deterioration
of vascular origin. In this setting nicardipine has been investigated in more than
6000 patients, with improvement of cognitive deterioration in more than 60% of patients
treated. The anti-hypertensive activity of nicardipine, its safety and effectiveness
in cognitive domain, suggests re-considering this drug in the treatment of cognitive
impairment of vascular origin and for reducing the risk of recurrent stroke in patients
at high risk of it.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of the Neurological SciencesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Calcium channel blockers in the spectrum of antihypertensive agents.Expert Opin Pharmacother. 2006; 7: 2385-2401
- Calcium channel blockers: an update.Am J Med. 2004; 116: 35-43
- ESH-ESC Task Force on the Management of Arterial Hypertension. 2007 ESH-ESC Practice Guidelines for the Management of Arterial Hypertension: ESH-ESC Task Force on the Management of Arterial Hypertension.J Hypertens. 2007; 25: 1751-1762
- Essential hypertension.Lancet. 2007; 370: 591-603
- Dihydropyridine calcium channel antagonists in the management of hypertension.Drugs. 2007; 67: 1309-1327
- Calcium antagonists for aneurismal subarachnoid haemorrhage.Cochrane Database Syst Rev. 2005; 1: CD000277
- Nicardipine and treatment of cerebrovascular diseases with particular reference to hypertension-related disorders.Clin Exp Hypertens. 1995; 17: 719-750
- Cerebral vasospasm after aneurismal subarachnoid haemorrhage: an overview of pharmacologic management.Pharmacotherapy. 2006; 26: 182-203
- Magnesium infusion for vasospasm prophylaxis after subarachnoid haemorrhage.Neurosurg. 2006; 105: 723-729
- Dose-escalation study of intravenous nicardipine in patients with aneurismal subarachnoid haemorrhage.J Nerosurg. 1988; 68: 393-400
- Effects of an intravenous injection of nicardipine on cerebral blood flow in subarachnoid haemorrhage caused by intracranial aneurysm.Agressologie. 1989; 30: 411-415
- Systemic vasomotor interaction between nicardipine and hypocapnic alkalosis in man.Intensive Care Med. 1992; 18: 89-92
- Combination of aminocaproic acid and nicardipine in treatment of aneurismal subarachnoid haemorrhage.Stroke. 1988; 19: 63-67
- The effects of ticlopidine and nicardipine on the prevention of symptomatic vasospasm after aneurismal rupture.No Shinkei Geka (Jap). 1988; 16: 741-746
- A randomized controlled trial of high-dose intravenous nicardipine in aneurismal subarachnoid haemorrhage. A report of the Cooperative Aneurysm Study.J Neurosurg. 1993; 78: 537-547
- A randomized trial of nicardipine in subarachnoid haemorrhage: angiographic and transcranial Doppler ultrasound results. A report of the Cooperative Aneurysm Study.J Neurosurg. 1993; 78: 548-553
- A randomized trial of two doses of nicardipine in aneurismal subarachnoid haemorrhage. A report of the Cooperative Aneurysm Study.J Neurosurg. 1994; 80: 788-796
- Calcium antagonists for aneurismal subarachnoid haemorrhage.Cochrane Database Syst Rev. 2000; : CD000277
- Preliminary experience with intra-arterial nicardipine as a treatment for cerebral vasospasm.AJNR Am J Neuroradiol. 2004; 25: 819-826
- Anesthetic considerations of selective intra-arterial nicardipine injection for intracranial vasospasm: a case series.J Neurosurg Anesthesiol. 2007; 19: 125-129
- Safety and feasibility of intra-arterial nicardipine for the treatment of subarachnoid haemorrhage-associated vasospasm: initial clinical experience with high-dose infusions.AJNR Am J Neuroradiol. 2007; 28: 844-848
- Efficacy and safety of nicardipine prolonged-release implants for preventing vasospasm in humans.Stroke. 2002; 33: 1011-1015
- Application of nicardipine prolonged-release implants: analysis of 97 consecutive patients with acute subarachnoid haemorrhage.Neurosurgery. 2005; 56: 895-902
- Effect of nicardipine prolonged-release implants on cerebral vasospasm and clinical outcome after severe aneurismal subarachnoid haemorrhage: a prospective, randomized, double-blind phase IIa study.Stroke. 2007; 38: 330-336
- Nicardipine prolonged-release implants for preventing cerebral vasospasm after subarachnoid haemorrhage: effect and outcome in the first 100 patients.Neurol Med Chir (Tokyo). 2007; 47: 389-394
- Stroke and coronary heart disease in mild hypertension: risk factors and the value of treatment.Br Med J. 1988; 296: 1565-1570
- Effects of antihypertensive drugs on the cerebral circulation.Acta Med Scand. 1993; 677: 143-147
- Calcium channel blockers and stroke.Aging Clin Exp Res. 2005; 17: 16-30
- Nicardipine in the prevention of cerebral infarction.Clin Ther. 1990; 12: 344-351
- Nicardipine in the treatment of outpatients with cerebrovascular disorders.Clin Ther. 1991; 13: 496-499
- The influence of nicardipine in patients with high risk of stroke.J Cardiovasc Pharmacol. 1990; 16: S16-S19
- Effect of nicardipine on somatosensory evoked potentials in patients with acute cerebral infarction.J Neurol Neurosurg Psychiatry. 1990; 53: 844-846
- Early treatment of ischemic stroke with a calcium antagonist.Stroke. 1991; 22: 437-441
- Should hypertension be treated after acute stroke?.Arch Neurol. 1993; 50: 855-862
- Nicardipine improves cerebral hemodynamics in acute and subacute stroke.Neurology. 1992; 42: 395
- Ensayo clìnico controlado a doble ciego: nicardipina frente a placebo en la isquemia cerebral focal aguda.Med Clin (Barc). 1988; 90: 690-692
- Preliminary experience with intra-arterial nicardipine in patients with acute ischemic stroke.Neurocrit Care. 2007; 7: 53-57
- A Comparison of nicardipine and labetalol for acute hypertension management following stroke.Neurocrit Care. 2008; 9: 167-176
- Low blood pressure and dementia in elderly people: the Kungsholmen project.BMJ. 1996; 312: 805-808
- Current and remote blood pressure and cognitive decline.JAMA. 1999; 281: 438-445
- Blood pressure, cognitive dysfunction and dementia.J Am Soc Hypertens. 2007; 1: 135-144
- Less atherosclerosis and lower blood pressure for a meaningful life perspective with more brain.Hypertension. 2007; 49: 389-400
- Protective effect of anti-hypertensive treatment on cognitive function in essential hypertension: analysis of published clinical data.J Neurol Sci. 2002; 203–204: 147-151
- Clinical effect of a new 1,4-dihydropyridine derivative, YC-93, in patients with cerebrovascular diseases.Arch Jpn Chir. 1979; 48: 400-403
- Effect of long-term treatment with YC-93 (nicardipine HCl), a 1,4,-dihydropyridine derivative, on obstructive cerebrovascular disorders.Clin Rep (Jap). 1981; 15: 426-434
- Clinical use of YC-93 (nicardipine HCl) in patients with cerebrovascular disorders. Part 2. Long-term use of YC-93.Clin Rep (Jap). 1981; 15: 233-242
- Clinical study of nicardipine hydrochloride (Perdipine) in patients with cerebral vascular disorders.Basic Clin Med (Jap). 1982; 16: 315-318
- Clinical efficacy of nicardipine hydrochloride for the treatment of various cerebrovascular disorders.Clin Rep (Jap). 1982; 16: 257-262
- Clinical effects of nicardipine hydrochloride (perdipine) on cerebrovascular disorders.Med Consult New Remed (Jap). 1983; 20: 97-102
- Effects of nicardipine and nifedipine on cerebral circulation in cerebrovascular disorders.J Cereb Blood Flow Met. 1983; 3: 560-561
- Effects of perdipine on post apoplectic disorders and cerebral arteriosclerosis.Clin Rep (Jap). 1983; 17: 153-162
- Clinical trial of YC-93 (nicardipine HCl) in patients with cerebral vascular disorders and cerebral blood flow disturbances.Clin Rep (Jap). 1983; 17: 263-277
- Effects and safety of nicardipine hydrochloride in patients with higher cerebral dysfunction.Med Consult New Remed (Jap). 1987; 24: 169
- Estudio clìnico de un derivado piridìnico nitrofenilado, la nicardipina, como agente vasodilatator cerebral.Rev Esp Geriatr Gerontol. 1984; 19: 311-315
- Ensayo clìnico a doble ciego parallelo de nicardipina frente a placebo en pacientes con insuficiencia vascular cerebral crònica.Med Clin (Barc). 1985; 84: 308-311
- Nicardipine in the treatment of the cerebral ischemic attack sequelae. Double-blind study versus placebo.in: International Symposium on Calcium Antagonists (New York). 1987
- An experimental, randomized, double-blind, placebo-controlled clinical trial to investigate the effect of nicardipine on cognitive function in patients with vascular dementia.Rev Neurol. 1999; 15: 835-845
- Study of the tolerability and effectiveness of nicardipine retard in cognitive deterioration of vascular origin.Rev Neurol. 2000; 30: 719-728
- Modificazioni delle resistenze vascolari cerebrali valutate mediante tecnica del doppler carotideo: effetti della nicardipina verso cinnarizina.Giorn It Angiol. 1985; 5: 41-59
- L' ipertensione arteriosa nella fase riabilitativa dell' ictus cerebrale.Clin Ther. 1989; 130: 29-35
- La nicardipina nella terapia dell' ipertensione arteriosa dell' anziano affetto da sindrome psico-organica.Clin Ther. 1989; 130: 171-178
- Calcium antagonist, cerebral ischemia and vasospasm.Can J Neurol Sci. 1984; 11: 239-246
- Effects of nicardipine and clonidine on cognitive functions and electroencephalography in hypertensive patients.Fundam. Clin. Pharmacol. 2002; 16: 527-535
- Nimodipine for primary degenerative, mixed and vascular dementia.Cochrane Database Syst Rev. 2002; : CD000147
- Efficacy and safety of nimodipine in subcortical vascular dementia: a randomized placebo-controlled trial.Stroke. 2005; 36: 619-624
- Valsartan lowers brain β-amyloid protein levels and improves spatial learning in a mouse model of Alzheimer disease.J Clin Invest. 2007; 117: 3393-3402
Article info
Publication history
Published online: March 23, 2009
Identification
Copyright
© 2009 Elsevier B.V. Published by Elsevier Inc. All rights reserved.
