UMEM Educational Pearls

Category: Pharmacology & Therapeutics

Title: Nicardipine vs Labetalol for Blood Pressure Management in the ED

Keywords: nicardipine, labetalol, blood pressure (PubMed Search)

Posted: 10/30/2011 by Bryan Hayes, PharmD (Emailed: 11/5/2011) (Updated: 11/5/2011)
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A recent randomized trial compared nicardipine as a continuous infusion to labetalol boluses to determine which one was more effective at lowering blood pressure to a target range within 30 minutes.

Median initial SBP for the 226 patients was 212 mm Hg. Within 30 minutes, nicardipine patients more often reached target range than labetalol (91.7 vs. 82.5%, P = 0.039). Of 6 BP measures (taken every 5 minutes) during the study period, nicardipine patients had higher rates of five and six instances within target range than labetalol (47.3% vs. 32.8%, P = 0.026).

What this means: Nicardipine is a reasonable choice for patients needing acute lowering of blood pressure (e.g., ischemic stroke with tPa).  Nicardipine seems to achieve faster and smoother lowering of blood pressure than labetalol therapy with less blood pressure readings outside the target range.


Peacock WF, Varon J, Baumann BM, et al. CLUE: a randomized comparative effectiveness trial of IV nicardipine versus labetalol use in the emergency department. Crit Care 2011;15(3):R157. Epub 2011 Jun 27.