Nimodipine


Concise Prescribing Info
Indications/Uses
Listed in Dosage.
Dosage/Direction for Use
Adult : PO Prophylaxis of neurological deficit following subarachnoid haemorrhage 60 mg 4 hrly for 21 days beginning w/in 4 days of onset of haemorrhage. IV Ischaemic neurological deficits following subarachnoid haemorrhage Initial: 1 mg/hr for 2 hr, up to 2 mg/hr if no severe decrease in BP is observed. For <70 kg body wt or unstable BP: Initial: ≤0.5 mg/hr. Start treatment at once and continue for 5-14 days. Total duration should not exceed 21 days if patient has received oral treatment.
Dosage Details
Intravenous
Ischaemic neurological deficits following subarachnoid hemorrhage
Adult: Initially, 1 mg/hr infusion for 2 hr given via bypass into a central vein, increase to 2 mg/hr if no severe decrease in BP is observed. For <70 kg body wt or unstable BP: Initially, ≤0.5 mg/hr. Treatment is started at once and continued for 5-14 days. Total duration should not exceed 21 days if patient has received oral treatment.

Oral
Prophylaxis of neurological deficit following subarachnoid haemorrhage
Adult: 60 mg 4 hrly beginning w/in 4 days of onset of haemorrhage and continued for 21 consecutive days.
Hepatic Impairment
Oral:
Initially, 30 mg 4 hrly.
Intravenous:
Initially, ≤0.5 mg/hr.
Administration
Cap: Should be taken on an empty stomach. Take 1 hr before or 2 hr after meals.
Tab: May be taken with or without food. Take consistently, either always w/ or always w/o meals.
Incompatibility
Incompatible w/ some plastics, including polyvinyl chloride (PVC). It must not be added to an infusion bag or bottle, or be mixed w/ other drugs.
Contraindications
Use w/in 1 mth of MI or an episode of unstable angina. Concomitant use w/ potent CYP3A4 inhibitors (e.g. clarithromycin, ritonavir, ketoconazole, nefazodone).
Special Precautions
Patients w/ cerebral oedema or severely raised intracranial pressure. Contents of oral capsules should be given only by mouth or through a feeding tube. It must never be administered IV or by any other parenteral route. Hepatic impairment. Pregnancy and lactation.
Adverse Reactions
Hypotension, oedema, ECG abnormalities, palpitations, rebound vasospasm, flushing, fluid retention, lower abdominal discomfort or cramps, constipation, mental depression, headache, lightheadedness, dizziness, dyspnoea, muscle pain, thrombocytopenia, anaemia, rash, pruritus, haematoma, diaphoresis.
MonitoringParameters
Careful monitoring of BP and pulse rate.
Overdosage
Symptoms: Excessive peripheral vasodilation, systemic hypotension, tachycardia, bradycardia, GI complaints, nausea. Management: Symptomatic and supportive treatment. Admin of vasopressor may be necessary if significant hypotension occurs. IV Ca salts have been also used for hypotension.
Drug Interactions
Plasma concentration and efficacy may be significantly reduced when administered w/ strong CYP3A4 inducers (e.g. rifampicin, carbamazepine, phenobarbital, phenytoin). May increase serum levels and toxicity of phenytoin. Increased plasma concentrations w/ cimetidine or sodium valproate.
Potentially Fatal: Increased risk of significant hypotension w/ concomitant potent CYP3A4 inhibitors (e.g. clarithromycin, ritonavir, ketoconazole, nefazodone).
Food Interaction
Increased serum levels w/ grapefruit juice. Decreased serum levels w/ St John's wort.
Action
Description: Nimodipine inhibits inflow of Ca ions into cells by blocking Ca channels or select voltage-sensitive areas resulting in relaxation of vascular smooth muscle and myocardium during depolarisation. Nimodipine has greater action on the cerebral vessels because of its high lipophilicity.
Pharmacokinetics:
Absorption: Rapidly absorbed from the GI tract. Bioavailability: Approx 13%. Time to peak plasma concentration: 1 hr.
Distribution: Crosses blood-brain barrier but concentrations in CSF are lower than those in plasma. Plasma protein binding: >95%.
Metabolism: Hepatically metabolised via CYP3A4 isoenzyme. Undergoes extensive first-pass metabolism.
Excretion: In faeces via bile, via urine (as metabolites). Terminal half-life: Approx 9 hr.
Storage
Store between 15-30°C. Protect from light.
References
Anon. Nimodipine. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 07/01/2014.

Buckingham R (ed). Nimodipine. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 07/01/2014.

McEvoy GK, Snow EK, Miller J et al (eds). Nimodipine. AHFS Drug Information (AHFS DI) [online]. American Society of Health-System Pharmacists (ASHP). https://www.medicinescomplete.com. Accessed 07/01/2014.

Nimodipine Capsule (Caraco Pharmaceutical Laboratories, Ltd.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 07/01/2014.

Serious Medication Errors from Intravenous Administration of Nimodipine Oral Capsules. U.S. FDA. https://www.fda.gov/. Accessed 07/01/2014.

Disclaimer: This information is independently developed by MIMS based on Nimodipine from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to MIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, MIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2020 MIMS. All rights reserved. Powered by MIMS.com
  • Nimotop
Register or sign in to continue
Asia's one-stop resource for medical news, clinical reference and education
Sign up for free
Already a member? Sign in