Intravenous use of the calcium-channel blocker nicardipine as second-line treatment in severe, early-onset pre-eclamptic patients.
OBJECTIVE
To evaluate the efficacy of intravenous administration of nicardipine as a second-line temporizing treatment in severe, early-onset, pre-eclamptic patients.


METHODS
An open, prospective, evaluation study.


METHODS
A high-care obstetric ward in a tertiary care centre.


METHODS
Twenty-seven early-onset, pre-eclamptic patients with a median gestational age of 27 weeks 1 day (range, 21 weeks 2 days-32 weeks 4 days) with treatment failure on standard intravenous antihypertensive drugs (ketanserin, dihydralazin or labetalol).


METHODS
Nicardipine infusion was started for temporizing management of pre-eclampsia at a dosage of 3 mg/h and was subsequently titrated according to blood pressure. Nicardipine treatment was continued for as long as the maternal and foetal conditions allowed.


METHODS
The endpoints of the study were defined as the percentage of patients reaching the target diastolic intra-arterial blood pressure (< 100 mmHg or < 90 mmHg in Haemolysis, Elevated Liver Enzymes, Low Platelet Count syndrome patients) within 1 h after the start of treatment, and the number of days of prolongation of pregnancy under nicardipine treatment. Maternal and foetal side effects, foetal death and neonatal outcome were assessed.


RESULTS
In all patients the target diastolic intra-arterial blood pressure was obtained within a median of 23 min (range, 5-60 min). Delivery was postponed for a median of 4.7 days (range, 1-26 days) using nicardipine treatment, in a maximum dosage ranging from 3 to 9 mg/h. Detailed haemodynamic parameters with corresponding nicardipine dosages were obtained in nine patients. In one-fifth of the patients, unwanted hypotensive periods were registered during treatment, manageable with dosage adaptation. Foetal well-being did not seem adversely affected.


CONCLUSIONS
This evaluation shows that nicardipine is a potent antihypertensive drug and can be used for temporizing management in severe, early-onset pre-eclampsia when other antihypertensive drugs have failed.
Hanff
Lidwien M
LM
Department of Hospital Pharmacy, Rotterdam, The Netherlands. l.hanff@erasmusmc.nl
Vulto
Arnold G
AG
Bartels
Pieter A
PA
Roofthooft
Daniella W E
DW
Bijvank
Bas Nij
BN
Steegers
Eric A P
EA
Visser
Willy
W
D000293:Adolescent; D000328:Adult; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000009:adverse effects; D001794:Blood Pressure / Q000187:drug effects; D002121:Calcium Channel Blockers / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D005333:Fetus / Q000187:drug effects; D005865:Gestational Age; D017359:HELLP Syndrome / Q000188:drug therapy / Q000503:physiopathology; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007231:Infant, Newborn; D007262:Infusions, Intravenous; D009529:Nicardipine / Q000008:administration & dosage* / Q000009:adverse effects; D011225:Pre-Eclampsia / Q000188:drug therapy* / Q000503:physiopathology; D011247:Pregnancy; D011256:Pregnancy Outcome; D012449:Safety; D017211:Treatment Failure
D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D009529:Nicardipine