Objective: Injectable nicardipine is increasingly used in managing neurovascular conditions. To understand its place in therapy, we conducted an evidenced-based literature review. Methods: The English-language literature in OVID and Cochrane databases was searched using combinations of these terms: intracerebral hemorrhage (ICH), neurology, neurosurgery, nicardipine, stroke, subarachnoid hemorrhage (SAH). Two-hundred and twenty-three abstracts were identified; after independent review by two individuals, four clinical guidelines, two meta-analyses, and four randomized controlled trials (RCT) were deemed relevant. Results: In clinical guidelines, based on expert opinion, nicardipine was recommended to manage hypertension in 1) ischemic stroke patients eligible for acute reperfusion therapy (alternatives: labetalol, nitropaste, and nitroprusside); and 2) ICH (alternatives: enalapril, esmolol, hydralazine, labetalol, nitroprusside, nitroglycerin). In a meta-analysis, nicardipine had no effect on death or dependency in patients with aneurysmal SAH [RR:0.97 (95%CI:0.78-1.20)]; adverse events were higher versus placebo [hypotension:34% vs. 5%; phlebitis:22% vs. 5%; pulmonary edema+azotemia: 6% vs. 2%]. In acute traumatic brain injury, nicardipine had no impact on death and severe disability [RR:0.25 (95%CI:0.05-1.27)]. Nicardipine's effect on cerebral blood flow was comparable to labetalol (+0.19±3.9 ml/100g/min vs. -1.55±3.2 ml/100g/min; p=0.39) in ICH, while it increased from baseline in SAH patients (42.1±12.3 ml/100g/min vs. 47±10.7 ml/100g/min;p<0.05). In a craniotomy RCT, nicardipine was less effective than labetalol in preventing emergent hypertension (50% vs. 82%; p=0.05) and was associated with more tachycardia (20% vs. 0%;p=0.11), hypotension (15% vs. 0%;p=0.23) and higher cost ($23.65±6.62 vs. $5.23±2.0;p<0.05). Mean arterial pressure remained depressed 20 minutes post-infusion compared to nitroprusside, despite lack of cumulative nicardipine plasma levels [60±2 mmHg vs. 73±4 mmHg; p<0.05] in spinal surgery patients. Conclusion: While nicardipine has a role in select neurovascular indications, recommendations are based on expert opinion. Moreover, a lack of benefit has been demonstrated in meta-analyses and RCT in other neurovascular indications, including aneurysmal SAH and acute traumatic brain injury.