nimodipine

nimodipine /ni·mo·di·pine/ (ni-mo´dĭ-pēn) a calcium channel blocker used as a vasodilator in the treatment of neurologic deficits associated with subarachnoid hemorrhage from a ruptured intracranial aneurysm.

---

Nimodipine (Nimotop)

A calcium-channel blocker, that is, a drug that relaxes arterial smooth muscle by slowing the movement of calcium across cell walls.

Mentioned in: Cerebral Aneurysm

---

nimodipine

[ni-mo′dĭpēn]

a calcium channel blocking agent used as a vasodilator in the treatment of neurologic deficits associated with subarachnoid hemorrhage from a ruptured intracranial aneurysm, administered orally.

---

nimodipine

Nimotop

Pharmacologic class: Calcium channel blocker

Therapeutic class: Cerebral vasodilator

Pregnancy risk category C

FDA Boxed Warning

• Don't give by I.V. or other parenteral route. Deaths and serious or life-threatening adverse events have occurred when capsule contents have been injected parenterally.

Action

Inhibits calcium transport into vascular smooth muscle cells, suppressing contractions; also dilates coronary and cerebral arteries

Availability

Capsules: 30 mg

⊘Indications and dosages

➣ Subarachnoid hemorrhage

Adults: 60 mg P.O. q 4 hours for 21 days. Therapy should start within 96 hours of subarachnoid hemorrhage.

Dosage adjustment

• Hepatic impairment

Contraindications

None

Precautions

Use cautiously in:
• hepatic impairment, hypotension
• elderly patients
• pregnant or breastfeeding patients (safety not established)
• children (safety not established).

Administration

• Give at least 1 hour before or 2 hours after meals. Don't let patient consume grapefruit or grapefruit juice within 1 hour before or 2 hours after dose.
• If patient can't swallow capsule, puncture it with sterile needle and empty contents into syringe. Administer through nasogastric tube, then flush with normal saline solution (30 ml).

Route	Onset	Peak	Duration
P.O.	Unknown	1 hr	4 hr

Adverse reactions

CNS: headache, depression

CV: hypotension, peripheral edema, ECG abnormalities, bradycardia, tachycardia

GI: nausea, diarrhea, abdominal discomfort

Musculoskeletal: muscle cramps

Respiratory: dyspnea

Skin: acne, flushing, rash

Interactions

Drug-drug. Other calcium channel blockers: enhanced cardiovascular effects

Drug-diagnostic tests. Liver function tests: abnormal results

Drug-food. Any food: decreased drug blood level and effects

Grapefruit juice, grapefruit juice: increased drug blood level and effects

Drug-herbs. Ephedra (ma huang), yohimbine: antagonism of nimodipine effects

St. John's wort: decreased drug blood level

Drug-behaviors. Alcohol use: increased hypotension

Patient monitoring

• Monitor weight and fluid intake and output. Stay alert for fluid retention.
• Assess neurologic status and mood, watching for signs of depression.
• Check vital signs and ECG.

Patient teaching

• Tell patient to complete full course of therapy (21 days).
• Advise patient to take on an empty stomach 1 hour before or 2 hours after a meal. Instruct him to not to consume grapefruit or grapefruit juice within 1 hour before or 2 hours after taking drug.
• Tell patient to report irregular heartbeat, shortness of breath, rash, or swollen hands or feet.
• Instruct patient to minimize GI upset by eating small, frequent meals.
• Advise patient to weigh himself daily and report sudden weight gain.
• As appropriate, review all other significant adverse reactions and interactions, especially those related to the drugs, tests, foods, herbs, and behaviors mentioned above.