School of Medicine and Health Sciences Poster Presentations

Title

Safe use of immediate release Nifedipine to wean off Nicardipine infusion in the ICU

Document Type

Poster

Abstract Category

Cardiology/Cardiovascular Research

Keywords

Nifedipine, Cardiovascular, Neuroscience, Critical Care

Publication Date

Spring 5-1-2019

Abstract

Background: Nicardipine infusions are commonly used in patients with severe hypertension who require strict BP control, and who are NPO, such as those with intracerebral hemorrhages. Options for transitioning to an oral regimen is limited, as long acting anti-hypertensives cannot be crushed down a feeding tube for those NPO patients. Nifedipine immediate release (IR) is a short-acting dihydropyridine calcium channel blocker used for hypertensive crisis. Safety concerns stemming from reports of cardiovascular events including myocardial infarction (MI), arrhythmias, and stroke have limited its use. We hypothesize that these harmful events occurred as a result of unrecognized hypotension in a less frequently monitored unit (i.e medical-surgical floor) and that the use of nifedipine IR is a safe anti-hypertensive agent when introduced in the intensive care unit (ICU) setting. Methods: Retrospective observational study evaluating the safety of nifedipine IR in ICU patients at the George Washington University Hospital from January 1, 2012 to January 31, 2017. Fifty consecutive patients treated with nifedipine IR, in order to wean a nicardipine infusion, were included in the review. The primary outcome was the incidence of nifedipine-associated hypotension and need for blood pressure (BP) support. Secondary outcomes included troponin elevation, cardiovascular events, or death. Results: Of the 50 patients reviewed, only one required BP support, and required phenylephrine to meet a therapeutic hypertension goal of raising the BP from 140 mmHg to a goal of 160-180 mmHg. Six patients experienced a mild troponin elevation during nifedipine administration (peak, 0.35 ng/dl). There were no new cardiovascular events such as an MI, arrhythmia, stroke, or EKG changes requiring intervention. Death occurred in 18 of the 50 cases. All 18 deaths were due to the underlying primary disease and/or withdrawal of care. Conclusion: These results suggest that nifedipine IR is a safe and effective agent for weaning patients off of a nicardipine infusion in the ICU.

Open Access

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Presented at Research Days 2019.

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Safe use of immediate release Nifedipine to wean off Nicardipine infusion in the ICU

Background: Nicardipine infusions are commonly used in patients with severe hypertension who require strict BP control, and who are NPO, such as those with intracerebral hemorrhages. Options for transitioning to an oral regimen is limited, as long acting anti-hypertensives cannot be crushed down a feeding tube for those NPO patients. Nifedipine immediate release (IR) is a short-acting dihydropyridine calcium channel blocker used for hypertensive crisis. Safety concerns stemming from reports of cardiovascular events including myocardial infarction (MI), arrhythmias, and stroke have limited its use. We hypothesize that these harmful events occurred as a result of unrecognized hypotension in a less frequently monitored unit (i.e medical-surgical floor) and that the use of nifedipine IR is a safe anti-hypertensive agent when introduced in the intensive care unit (ICU) setting. Methods: Retrospective observational study evaluating the safety of nifedipine IR in ICU patients at the George Washington University Hospital from January 1, 2012 to January 31, 2017. Fifty consecutive patients treated with nifedipine IR, in order to wean a nicardipine infusion, were included in the review. The primary outcome was the incidence of nifedipine-associated hypotension and need for blood pressure (BP) support. Secondary outcomes included troponin elevation, cardiovascular events, or death. Results: Of the 50 patients reviewed, only one required BP support, and required phenylephrine to meet a therapeutic hypertension goal of raising the BP from 140 mmHg to a goal of 160-180 mmHg. Six patients experienced a mild troponin elevation during nifedipine administration (peak, 0.35 ng/dl). There were no new cardiovascular events such as an MI, arrhythmia, stroke, or EKG changes requiring intervention. Death occurred in 18 of the 50 cases. All 18 deaths were due to the underlying primary disease and/or withdrawal of care. Conclusion: These results suggest that nifedipine IR is a safe and effective agent for weaning patients off of a nicardipine infusion in the ICU.