Nimodipine

Indications
 Oral
Prophylaxis of neurological deficit following subarachnoid haemorrhage
Adult: 60 mg every 4 hr beginning within 4 days of onset of haemorrhage and continued for 21 consecutive days.
Hepatic impairment: 30 mg every 4 hr in hepatic cirhosis.
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 weight or unstable BP: Initial dose: ≤500 mcg/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.
Hepatic impairment: Initial dose: ≤500 mcg/hr.

Special Populations: Patients with impaired hepatic function: Prophylaxis of neurological deficit: ½ of the usual dose with close BP monitoring. Patients with unstable BP and hepatic impairment: Prophylaxis of neurological deficit in cerebral ischaemia following aneurysmal or traumatic haemorrhage: Initially, 500 mcg/hr or less.
Warnings / Precautions
 Cerebral oedema, severely raised intracranial pressure, idiopathic hypertrophic subaortic stenosis (IHSS), elderly, severe liver disease. Inadvertent IV admin of the contents of capsules has resulted in CV collapse, hypotension, bradycardia and death. Tablets should not be administered concomitantly with IV solution.
Adverse Reactions
 Peripheral oedema, hypotension, palpitations, tachycardia, flushing, dizziness, headache, nausea, increased micturition frequency, lethargy, eye pain, mental depression, visual disturbances, gingival hyperplasia, myalgia, tremor, impotence, fever, paradoxical increase in ischaemic chest pain during initiation of treatment, rashes, abnormalities in liver function (including cholestasis), GI obstruction in some tablets covered in indigestable membrane.
Potentially Fatal: Angina/MI, symptomatic hypotension.
Overdose Reactions
 Hypotension and bradycardia; hyperglycemia, metabolic acidosis, coma. Treatment is symptomatic.
Drug Interactions
 Potentiates hypotensive effect of antihypertensives. Additive effects with sildenafil, tadalafil, vardenafil. Reduced effects with calcium. Decreased levels/effects with CYP3A4 inducers (e.g aminoglutethimide, carbamazepine, nafcillin, nevirapine, phenobarbital, phenytoin, and rifamycins). Increased levels/effects with cimetidine, sodium valproate, CYP3A4 inhibitors (e.g. azole antifungals, clarithromycin, diclofenac, doxycycline, erythromycin, imatinib, isoniazid, nefazodone, nicardipine, propofol, protease inhibitors, quinidine, telithromycin, and verapamil).
See Below for More nimodipine Drug Interactions
Food Interactions
 Increased levels/effects with grapefruit juice, garlic. Decreased serum levels with St John's wort. Avoid ephedra, yohimbe, ginseng (may worsen hypertension).
Mechanism of Actions
 Nimodipine inhibits inflow of calcium ions into cells by blocking calcium channels or select voltage-sensitive areas resulting in relaxation of vascular smooth muscle. Nimodipine has greater action on the cerebral vessels because of its high lipophilicity.
Absorption: Absorbed rapidly from the GI tract (oral).
Distribution: Blood-brain barrier. Protein-binding: 95%.
Metabolism: Extensive hepatic first-pass metabolism.
Excretion: In faeces via bile, via urine (as metabolites). Terminal elimination half-life: 9 hr.
Administration
 Cap: Should be taken on an empty stomach. (Take on an empty stomach 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.)
Storage Conditions
 Intravenous: Store <25°C. Protect from light. Oral: Store <25°C. Protect from light.
ATC Classification
 C08CA06 - nimodipine ; Belongs to the class of dihydropyridine derivative selective calcium-channel blockers with mainly vascular effects. Used in the treatment of cardiovascular diseases.
Storage
 Intravenous: Store <25°C. Protect from light. Oral: Store <25°C. Protect from light.
Available As
  • Nimodipine 10 mg
  • Nimodipine 30 mg

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