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J Stroke Cerebrovasc Dis. 2016 Sep;25(9):2290-4. doi: 10.1016/j.jstrokecerebrovasdis.2016.05.021. Epub 2016 Jun 14.

Reducing Cost and Intravenous Duration of Nicardipine in Intracerebral Hemorrhage Patients via an Interdisciplinary Approach.

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Department of Neurology, University of California San Francisco, San Francisco, California. Electronic address:
Department of Neurology, Kaiser-Permanente Santa Clara, Santa Clara, California.
Department of Pharmacy, University of California San Francisco, San Francisco, California.
Department of Neurology, University of California San Francisco, San Francisco, California.



The mainstay of acute management of intracerebral hemorrhage (ICH) is blood pressure reduction. Intravenous (IV) nicardipine is an effective but costly intervention for blood pressure reduction in the intensive care unit (ICU). Earlier transition to oral (PO) antihypertensive agents may reduce ICU length of stay (LOS) and associated costs. We sought to study the effectiveness of an interdisciplinary intervention to start earlier transition to PO antihypertensives.


From July 2011 to July 2012, patients with ICH who received IV nicardipine were reviewed and screened for eligibility by an interdisciplinary team including physicians and pharmacists. These patients were compared to a control group 1 year prior to this intervention. The duration of nicardipine treatment (median hours), estimated costs, and ICU LOS were measured.


A total of 35 patients and 44 controls were studied. The median hours of IV nicardipine use were significantly decreased from a baseline mean of 118 to 30 hours (P < .001); total cost savings per year was $433,566 ($18,475 per patient). The average LOS remained similar (8.4 versus 8.9 days, P < .990). In a follow-up study 1 year later, after the intervention was no longer used, a sample of 21 consecutive patients was reviewed and the duration of IV nicardipine treatment had increased to a mean of 96 hours.


A physician and pharmacist-led project to initiate oral antihyperintensive medications earlier was successful in reducing the duration of IV nicardipine treatment in patients with ICH while leading to substantial cost savings.


ICH; Stroke; cost-effectiveness; intracerebral hemorrhage; neuro-ICU; neurocritical care; nicardipine; quality improvement

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