Intravenous nicardipine as a first-line antihypertensive drug in neonates.

OBJECTIVE

Prospective recording of IV nicardipine efficacy and safety as a first-line antihypertensive drug in neonates.

PATIENTS: Twenty neonates (15 preterm) with systemic hypertension due to steroids administration (n = 14), polycystic kidney disease (n = 1), renal vein thrombosis (n = 1), coarctation of aorta (n = 1) or from an undetermined cause (n = 3).

INTERVENTIONS: The initial nicardipine dosage was 0.5 microg/kg/min in 17 patients. The maximal nicardipine dosage was 0.74+/-0.41 microg/kg/ min (0.5-2.0). The duration of treatment was 14.6+/-11.6 days.

RESULTS

Systolic blood pressure significantly decreased after 3, 6, 12, 24 and 48 h of nicardipine treatment (-20+/-11%, -19+/-10%, -20+/-8%, -20+/-10% and -20+/-12%, respectively). The decrease in blood pressure remained significant over the subsequent days of treatment. No hypotension or other clinical side effects were observed.

CONCLUSIONS

Both additional pharmacokinetic and pharmacodynamic studies remain mandatory to improve the dosage regimens and assess the efficacy and safety of nicardipine infusion in hypertensive neonates.