USA: The use of nicardipine as a first-line antihypertensive in infants is safe, says a recent study in the World Journal for Pediatric and Congenital Heart Surgery. The use of nicardipine as initial antihypertensive therapy instead of sodium nitroprusside can significantly reduce the medication costs without jeopardizing clinical outcomes.
Nicardipine use in congenital cardiac surgery has been guarded due to the calcium sensitivity of immature myocardium and the lack of clinical data. Neonates with single ventricles have been excluded in reports of nicardipine use. Entela Lushaj, Department of Surgery-Cardiothoracic, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA, and colleagues set out to compare the use of nicardipine and sodium nitroprusside for postoperative blood pressure control in young patients recovering from cardiac surgery.

For this purpose, the researchers retrospectively reviewed all neonates (<30 days) and young infants (31-180 days) who received either sodium nitroprusside or nicardipine as first-line therapy for blood pressure control. Separate counting of each index operation of some patients having multiple index operations was done regarding treatment with sodium nitroprusside or nicardipine.
The study led to the following findings:
A total of 59 patients underwent 70 procedures (24 as neonates and 46 as infants).
Nicardipine was administered as initial therapy following 33 procedures (n = 28 patients), and sodium nitroprusside was administered as initial therapy following 37 index procedures (n = 31 patients).
The duration of treatment was longer when sodium nitroprusside was the initial treatment.
15% patients that received nicardipine required a second blood pressure management agent, and 19% patients that received sodium nitroprusside required a second agent.
No adverse events related to titratable antihypertensive therapy were recorded in any treatment group.
The use of nicardipine resulted in significant medication cost reduction. Based on average wholesale price, patient costs for sodium nitroprusside use were $182,952 ($5,544/pt), while costs for nicardipine were only $24,960 ($780/pt).
"Nicardipine can be safely used as a first-line antihypertensive in infants," wrote the authors. "Nicardipine use as initial antihypertensive therapy instead of sodium nitroprusside can lead to a significant reduction in medication costs without jeopardizing clinical outcomes."
Reference:
Lushaj E, Hermsen JL, Nelson K, Amond K, Bogenschutz M, Arndt S, Wilhelm M, Anagnostopoulos PV. Nicardipine Is a Safe, Efficacious, and Cost-Effective Antihypertensive for Neonates and Young Infants Undergoing Cardiac Surgery. World J Pediatr Congenit Heart Surg. 2022 May;13(3):341-345. doi: 10.1177/21501351221080173. PMID: 35446217.