IntravenousIschaemic neurological deficits following subarachnoid hemorrhageAdult: 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.
OralProphylaxis of neurological deficit following subarachnoid haemorrhageAdult: 60 mg 4 hrly beginning w/in 4 days of onset of haemorrhage and continued for 21 consecutive days.
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Oral:
Initially, 30 mg 4 hrly.
Intravenous:
Initially, ≤0.5 mg/hr.
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cap: Should be taken on an empty stomach. tab: May be taken with or without food. Take consistently, either always w/ or always w/o meals.
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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.
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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).
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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.
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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.
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Careful monitoring of BP and pulse rate.
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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.
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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).
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Increased serum levels w/ grapefruit juice. Decreased serum levels w/ St John's wort.
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Description: Mechanism of Action: 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.
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Store between 15-30°C. Protect from light.
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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.
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