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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.
Inhibits calcium transport into vascular smooth muscle cells, suppressing contractions; also dilates coronary and cerebral arteries
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.
• Hepatic impairment
Use cautiously in:
• hepatic impairment, hypotension
• elderly patients
• pregnant or breastfeeding patients (safety not established)
• children (safety not established).
• 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).
CNS: headache, depression
CV: hypotension, peripheral edema, ECG abnormalities, bradycardia, tachycardia
GI: nausea, diarrhea, abdominal discomfort
Musculoskeletal: muscle cramps
Skin: acne, flushing, rash
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
• 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.
• 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.