title: Risk Factors of Nicardipine-Related Phlebitis in Acute Stroke Patients.
abstract: OBJECTIVE
  Intravenous nicardipine is generally used to treat hypertension in acute stroke patients but is associated with frequent phlebitis. We aimed to identify the incidence and risk factors of phlebitis in such patients.
  
  
  METHODS
  The incidence and risk factors of phlebitis were investigated in 358 acute stroke patients from July 2014 to June 2015.
  
  
  RESULTS
  In total, 138 patients received intravenous nicardipine. Of 45 (12.6%) phlebitis patients in 358 acute stroke patients, 42 (93.3%) were administered nicardipine, which was significantly associated with phlebitis occurrence (P < .01). Other candidate risk factors of phlebitis of acute stroke patients in univariate analysis were intracerebral hemorrhage (P < .01), nicardipine injection to paralyzed limbs (P = .023), dilution of nicardipine with normal saline (P < .01), higher maximum flow rate of nicardipine (7.2 ± 4.1 mg/h versus 1.6 ± 3.1 mg/h; P < .01), and higher maximum concentration of nicardipine (271.5 ± 145.0 µg/mL versus 37.6 ± 75.0 µg/mL; P < .01). The only statistically significant independent factor following multivariate logistic regression analysis, according to the optimal cutoff values defined from receiver operating characteristic curve analyses, was the maximum concentration of nicardipine greater than 130 µg/mL (OR 57.9; 95% CI 21.5-156; P < .01). A gradual decline of pH below 4.3 was observed when the concentration of nicardipine solution increased to greater than or equal to 130 µg/mL in vitro.
  
  
  CONCLUSIONS
  Nicardipine-related phlebitis is frequently observed in acute stroke patients and is significantly associated with administration of a maximum concentration of nicardipine greater than 130 µg/mL.
authors.affiliation: Pharmaceutical Department, Kochi Health Sciences Center, Kochi City, Kochi, Japan.
authors.forename: Kei
authors.initials: K
authors.lastname: Kawada
authors.affiliation: Department of Neurosurgery, Kochi Health Sciences Center, Kochi City, Kochi, Japan. Electronic address: tsuyoshi@ya2.so-net.ne.jp.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Ohta
authors.affiliation: Pharmaceutical Department, Kochi Health Sciences Center, Kochi City, Kochi, Japan.
authors.forename: Koudai
authors.initials: K
authors.lastname: Tanaka
authors.affiliation: Pharmaceutical Department, Kochi Health Sciences Center, Kochi City, Kochi, Japan.
authors.forename: Naoto
authors.initials: N
authors.lastname: Kadoguchi
authors.affiliation: Pharmaceutical Department, Kochi Health Sciences Center, Kochi City, Kochi, Japan.
authors.forename: Souichi
authors.initials: S
authors.lastname: Yamamoto
authors.affiliation: Department of Neurosurgery, Kochi Health Sciences Center, Kochi City, Kochi, Japan.
authors.forename: Masanori
authors.initials: M
authors.lastname: Morimoto
mesh_terms: D061605:Administration, Intravenous; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000009:adverse effects*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009529:Nicardipine / Q000008:administration & dosage / Q000009:adverse effects*; D016017:Odds Ratio; D010689:Phlebitis / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents; D009529:Nicardipine
keywords: Phlebitis; acute stroke; nicardipine; risk factor