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. Design An open, prospective, evaluation study. Setting A high-care obstetric ward in a tertiary care centre. Patients 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 anti hypertensive drugs (ketanserin, dihydralazin or labetalol). Intervention 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. Main outcome measures 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 4.7 days (range, 1-26 days) using nicardipine treatment, a maximum dosage ranging from 3 to 9 mg/h. Detailed haemodynamic parameters with corresponding dosages were obtained in nine patients. In one-fifth of patients, unwanted hypotensive periods were registered during treatment, manageable with dosage adaptation. Foetal well-being did not seem adversely affected. Conclusion 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.