Nimotop

nimodipine

Nimotop

Pharmacologic class: Calcium channel blocker

Therapeutic class: Cerebral vasodilator

Pregnancy risk category C

FDA Box 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).

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.

niMODipine

(nye-moe-di-peen) ,

Nimotop

(trade name),

Nymalize

(trade name)

Classification

Therapeutic: subarachnoid hemorrhage therapy agents
Pharmacologic: calcium channel blockers
Pregnancy Category: C

Indications

Management of subarachnoid hemorrhage.

Action

Inhibits the transport of calcium into vascular smooth muscle cells, resulting in inhibition of excitation-contraction coupling and subsequent contraction.
Potent peripheral vasodilator.

Therapeutic effects

Prevention of vascular spasm after subarachnoid hemorrhage, resulting in decreased neurologic impairment.

Pharmacokinetics

Absorption: Well absorbed following oral administration but extensively metabolized, resulting in ↓ bioavailability.
Distribution: Crosses the blood-brain barrier; remainder of distribution unknown.
Protein Binding: >95%.
Metabolism and Excretion: Mostly metabolized by the liver; ≤10% excreted unchanged by kidneys.
Half-life: 1–2 hr.

Time/action profile (vasodilation)

ROUTEONSETPEAKDURATION
POunknown1 hr4 hr

Contraindications/Precautions

Contraindicated in: Hypersensitivity;Systolic BP <90 mm Hg.Concurrent use of strong CYP3A4 inhibitors (↑ risk of hypotension)Concurrent use of strong CYP3A4 inducers (↓ efficacy)
Use Cautiously in: Severe hepatic impairment (dose ↓ recommended);Severe renal impairment;History of serious ventricular arrhythmias or HF; Obstetric / Lactation / Pediatric: Safety not established; Geriatric: Dose ↓ recommended due to↑ risk of hypotension.

Adverse Reactions/Side Effects

Central nervous system

  • abnormal dreams
  • anxiety
  • confusion
  • dizziness
  • drowsiness
  • headache
  • nervousness
  • psychiatric disturbances
  • weakness

Ear, Eye, Nose, Throat

  • blurred vision
  • disturbed equilibrium
  • epistaxis
  • tinnitus

Respiratory

  • cough
  • dyspnea

Cardiovascular

  • arrhythmias (life-threatening)
  • HF (life-threatening)
  • chest pain
  • hypotension
  • palpitations
  • peripheral edema
  • syncope
  • tachycardia

Gastrointestinal

  • ↑ liver enzymes
  • anorexia
  • constipation
  • diarrhea
  • dry mouth
  • dysgeusia
  • dyspepsia
  • nausea
  • vomiting

Genitourinary

  • dysuria
  • nocturia
  • polyuria
  • sexual dysfunction
  • urinary frequency

Dermatologic

  • dermatitis
  • erythema multiforme
  • flushing
  • ↑ sweating
  • photosensitivity
  • pruritus/urticaria
  • rash

Endocrinologic

  • gynecomastia
  • hyperglycemia

Hematologic

  • anemia
  • leukopenia
  • thrombocytopenia

Metabolic

  • weight gain

Musculoskeletal

  • joint stiffness
  • muscle cramps

Neurologic

  • paresthesia
  • tremor

Miscellaneous

  • stevens-johnson syndrome (life-threatening)
  • gingival hyperplasia

Interactions

Drug-Drug interaction

Strong CYP3A4 inhibitors, including clarithromycin, telithromycin, indinavir, nelfinavir, ritonavir, saquinavir, boceprevir, telaprevir, ketoconazole, itraconazole, posaconazole, voriconazole, conivaptan, and nefazodone may ↑ levels and the risk of hypotension; avoid concurrent useStrong CYP3A4 inducers, including carbamazepine, phenobarbital, phenytoin, and rifampin may ↓ levels and effects; avoid concurrent useAdditive hypotension may occur when used concurrently with fentanyl, other antihypertensives, nitrates, acute ingestion of alcohol, or quinidine.St. John's wort may ↓ levels and effect; avoid concurrent useGrapefruit and grapefruit juice ↑ levels and effect; avoid concurrent use.

Route/Dosage

Oral (Adults) 60 mg every 4 hr for 21 days; therapy should be started within 96 hr of subarachnoid hemorrhage.

Hepatic Impairment

Oral (Adults) 30 mg every 4 hr for 21 days; therapy should be started within 96 hr of subarachnoid hemorrhage.

Availability (generic available)

Capsules: 30 mg
Oral solution: 3 mg/mL

Nursing implications

Nursing assessment

  • Assess patient’s neurologic status (level of consciousness, movement) prior to and periodically following administration.
  • Monitor BP and pulse prior to therapy and periodically during therapy.
  • Monitor intake and output ratios and daily weight. Assess for signs of HF (peripheral edema, rales/crackles, dyspnea, weight gain, jugular venous distention).
  • Assess for rash periodically during therapy. May cause Stevens-Johnson syndrome. Discontinue therapy if severe or if accompanied with fever, general malaise, fatigue, muscle or joint aches, blisters, oral lesions, conjunctivitis, hepatitis, and/or eosinophilia.
  • Lab Test Considerations: Total serum calcium concentrations are not affected by calcium channel blockers.
    • Monitor serum potassium periodically. Hypokalemia ↑ risk of arrhythmias; should be corrected.
    • Monitor renal and hepatic functions periodically. Several days of therapy may cause ↑ hepatic enzymes, which return to normal upon discontinuation of therapy.
    • May occasionally cause ↓ platelet count.

Potential Nursing Diagnoses

Ineffective tissue perfusion (Indications)

Implementation

  • Do not confuse nimodipine with nicardipine or nifedipine.
    • Begin administration within 96 hr of subarachnoid hemorrhage and continue every 4 hr for 21 consecutive days.
  • Administer by PO route ONLY; when administered IV or parenterally, may cause serious adverse events, including death.
  • Oral: If patient is unable to swallow capsule, make a hole in both ends of the capsule with a sterile 18-gauge needle and extract the contents into a syringe. Empty contents into water or nasogastric tube and flush with 30 mL normal saline.
    • Administer oral solution 1 hr before or 2 hr after meals. For administration via NG or gastric tube, administer via syringe included, then refill syringe with 20 mL of 0.9% saline water solution; flush remaining contents from NG or gastric tube into stomach.

Patient/Family Teaching

  • Advise patient to take medication as directed, even if feeling well. Take missed doses as soon as possible unless almost time for next dose; do not double doses. May need to be discontinued gradually.
    • Advise patient to avoid grapefruit or grapefruit juice during therapy.
    • Caution patient to change positions slowly to minimize orthostatic hypotension.
    • May cause drowsiness or dizziness. Advise patient to avoid driving or other activities requiring alertness until response to the medication is known.
    • Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to avoid concurrent use of alcohol or OTC medications and herbal products, especially cold preparations, without consulting health care professional.
    • Advise patient to notify health care professional if rash, irregular heartbeats, dyspnea, swelling of hands and feet, pronounced dizziness, nausea, constipation, or hypotension occurs or if headache is severe or persistent.
    • Caution patient to wear protective clothing and use sunscreen to prevent photosensitivity reactions.
    • Advise female patient to notify health care professional if pregnancy is planned or suspected or if breast feeding.

Evaluation/Desired Outcomes

  • Improvement in neurologic deficits due to vasospasm following subarachnoid hemorrhage.

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
References in periodicals archive ?
Nimodipine (ND), commercially known as Nimotop, is 3-(2-methoxyethyl) 5-propan-2-yl 2,6-dimethyl-4-(3-nitrophenyl)- 1,4-dihydropyridine-3,5-dicarboxy- late.
Common calcium channel blockers include: verapamil (Calan, Isoptin), nifedipine (Procardia, Adalat) and nimodipine (Nimotop).
You may be getting too little of these medications if you're drinking grapefruit juice: Calcium channel-blockers, including Norvase, Plendil, Cardene, Procardia, Adalat, Nifedical, and Nimotop. Certain juices can decrease their absorption, preventing them from working effectively.
* Blood pressure medications known as calcium channel blockers, including felodipine (Plendil), nifedipine (Adalat, Procardia), nimodipine (Nimotop) and nisoldipine (Sular)
Nimodipine soft gel capsules are AB-rated equivalents to Nimotop capsules, marketed by Bayer Corp.
(Woodcliff Lake NJ) won approval for a generic version of Nimotop, which prevents brain damage resulting from aneurysm or hemorrhage.
The preventive agents were flunarizine (Sibelium), cyproheptadine (Periactin), amitriptyline (Elavil), divalproex sodium (Depakote), topiramate (Topamax), levetiracetam (Keppra), propranolol (Inderal), trazodone (Desyrel), pizotifen (Sandomigran), nimodipine (Nimotop), and clonidine (Catapres).
Nimodipine (Nimotop) appears to have marked selectivity for the cerebral vasculature.
The University of Sydney Table 1 Drugs whose metabolism is inhibited and bioavailability increased by grapefruit juice (6,7) Anti-hypertensive Calcium channel blockers FELODPINE ('Agon'; 'felodur'; 'Plendil' NIFEDIPINE ('Adalat'; 'Nyefax') NISOLDIPINE NITRENDIPINE NIMODIPINE ('Nimotop') Certain HMG CoA Reductase inhibitors SIMVASTATIN ('Lipex'; 'Zocor') LOVASTATIN ATORVASTATIN ('Lipitor') Immunomodifiers CYCLOSPORIN ('Neoral') TACROLIMUS ('Prograf') An Anti-convulsant CARBAMAZEPINE ('Tegretol') Certain Benzodiazepine sedatives MIDAZOLAM ('Hypnovel') TRIAZOLAM ('Halcion') Certain Anti-viral agents INDINAVIR ('Crixivan') SAQUINAVIR ('Invirase'; 'Fortovase') GI Motility stimulant CISAPRIDE ('Prepulsid') An Azopirone Anxiolytic BUSPIRONE ('Buspar') (9)
The others are Eulexin, Nimotop, Relafen, Dermatop, Penetrex, and Cardiogen-82.
has received Food and Drug Administration approval to manufacture a generic version of Nimotop, a medication that prevents brain damage resulting from aneurysm or hemorrhage.
Her medications included nebulizer treatments, subcutaneous heparin, nimodipine (Nimotop), phenytoin (Dilantin), lansoprazole (Prevacid), metoprolol (Toprol XL), the antithyroid medication methimazole (Tapazole), and labetalol and acetaminophen as needed.