Acute antihypertensive therapy in pregnancy-induced hypertension: is nicardipine the answer?

Hypertensive disorders in pregnancy constitute one of the most frequent medical complications during gestation. Unfortunately, maternal and perinatal mortality remains significant worldwide in this population. Not infrequently, patients with severe preeclampsia will need parenteral agents to achieve rapid blood pressure control to avoid end-organ damage. During the last decades, new antihypertensive medications have become available for management of hypertensive crisis. One of these agents is the calcium channel blocker nicardipine. Nicardipine has been used extensively in different clinical settings including neurosurgery, cardiothoracic surgery, transplant medicine, and internal medicine patients. Minimal data exist in the literature regarding the use of this medicine during pregnancy. The purpose of this article is to review the pharmacological properties of nicardipine, the available literature regarding its use during pregnancy, and potential interactions with other medicines used commonly in preeclampsia, as well as potential side effects directly affecting the peripartum period.