Intravenous nicardipine for severe hypertension in pre-eclampsia - effects of an acute treatment on mother and foetus

Abstract

Acute nicardipine therapy can induce severe maternal tachycardia. No severe foetal or neonatal adverse effects occurred. This dose scheme requires comparison with alternative therapeutic options.

Short-term treatment of severe hypertension of pregnancy: prospective comparison of nicardipine and labetalol

“…A study designed to evaluate transplacental passage of nicardipine showed that fetal plasma concentrations of nicardipine reached only 6-9% of maternal plasma values [29], and that tissue concentrations were nearly undetectable a few hours after administration, suggesting that nicardipine does not accumulate in the plasma, membranes, or umbilical cord. Clinical studies with intravenous nicardipine in preeclampsia are scarce and often not controlled [13,14].…”

“…The results of our study are in agreement with those of previous reports. Carbonne et al [13] observed an increase in heart rate below 13%, and Aya et al [14] noted mild tachycardia, defined as an increase in less than 20% of the baseline value, in 50 of their patients.…”

“…However, these effects have been linked to the substantially elevated doses used in animal studies (6-20 times those currently indicated in human hypertension). Two open-label studies evaluated nicardipine in the treatment of pregnancy related hypertension [13,14]. To our knowledge, we are unaware of a controlled trial evaluating the efficacy and safety of nicardipine in severe hypertension of pregnancy.…”

État des connaissances : prise en charge thérapeutique de la prééclampsie

“…Néanmoins, il semble que la nicardipine intraveineuse puisse être plutôt considérée comme une arme thérapeu-tique efficace à la dose de 3 à 9mg par heure, mais plutôt de deuxième ligne après échec d'autres traitements (dihydralazine ou labetalol) [24]. En effet, les effets secondaires maternels rapportés ne sont pas exceptionnels avec tachycardie, flushes, nausées, céphalées et vertiges [25]. Cette possibilité pourrait être également confirmée par la comparaison nifédipine-labetalol qui penche en faveur des anticalciques pour la rapidité de contrôle de l'hypertension et pour l'amélioration de la diurèse maternelle [26].…”

Antihypertensive therapy in pregnancy

“…Although there are sporadic reports of ketanserin for urgent blood pressure control [39], its efficacy for this indication seems less than that of hydralazine [16•]. There are isolated reports suggesting utility for sublingual nitrates [47] or the intravenous preparation of nicardipine [48]. We are aware of no published studies reporting a significant experience with fenoldapam in pregnancy.…”