Intravenous Ischaemic neurological deficits following subarachnoid haemorrhage
Adult: In patients weighing ≥70 kg with stable blood pressure: Initially, 1 mg/hour for 2 hours, may increase dose to 2 mg/hour if tolerated or with no severe fall in blood pressure. In patients weighing <70 kg with unstable blood pressure: Reduce initial infusion to 0.5 mg/hour (or less as necessary). All doses are administered as continuous IV infusion via central line catheter using an infusion pump connected to a three-way stopcock concomitantly flowing together with either NaCl 0.9%, dextrose 5% in water, lactated Ringer's solution, or other compatible solutions. Treatment duration: Prophylaxis: Initiate within 4 days of onset of haemorrhage then continue during the period of Max risk of vasospasm (i.e. up to 10-14 days after haemorrhage). Treatment: Initiate therapy as soon as possible then continue for at least 5 days up to Max of 14 days. In case of surgical intervention during prophylactic or therapeutic administration, continue IV infusion post-operatively for at least 5 days. The total treatment duration must not exceed 21 days if administered sequentially with oral formulation. Dosage and treatment recommendations may vary among individual products or between countries (refer to specific product or local guidelines).
Oral Ischaemic neurological deficits following subarachnoid haemorrhage
Adult: After prophylactic or therapeutic administration of IV infusion therapy: 60 mg 4 hourly for approx 7 days. Max total duration: 21 days.
Oral Prophylaxis of ischaemic neurological deficit following subarachnoid haemorrhage
Adult: 60 mg 4 hourly. Initiate treatment within 4 days of onset of aneurysmal subarachnoid haemorrhage then continue for 21 days.
Hepatic Impairment
Oral: Prophylaxis of ischaemic neurological deficit following subarachnoid haemorrhage; Ischaemic neurological deficits following subarachnoid haemorrhage:
In patients with cirrhosis: 30 mg 4 hourly; closely monitor blood pressure and heart rate.
Intravenous: Ischaemic neurological deficits following subarachnoid haemorrhage:
In patients with cirrhosis: Dose reduction may be needed; closely monitor the blood pressure. Dosage recommendations may vary among individual products or between countries (refer to specific product or local guidelines).
Administration
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.
Incompatibility
Incompatible with polyvinyl chloride (PVC) giving sets or containers.
Contraindications
IV: Administration during or within 1 month of MI or episode of unstable angina. Oral: Concomitant use with rifampicin, anti-epileptic drugs (e.g. carbamazepine, phenobarbital, phenytoin.
Special Precautions
Patient with hypotension (systolic blood pressure <100 mmHg), cerebral oedema, severely increased intracranial pressure, hypertrophic cardiomyopathy with outflow tract obstruction. Nimotop tablets and solution for IV infusion may be given sequentially; do not use concomitantly. Contents of oral capsules should be given only by mouth or through a nasogastric tube or percutaneous endoscopic gastrostomy (PEG); do not administer via IV or any parenteral routes. Not recommended for use in traumatic subarachnoid haemorrhage. Concomitant use with CYP3A4 inhibitors (e.g. clarithromycin, erythromycin, ritonavir, ketoconazole, quinupristin + dalfopristin, nefazodone, fluoxetine, cimetidine, valproic acid). Hepatic impairment (particularly in patients with cirrhosis). Elderly. Pregnancy and lactation.
Adverse Reactions
Significant: Symptomatic hypotension with or without syncope, angina and/or MI. Blood and lymphatic system disorders: Thrombocytopenia. Cardiac disorders: Tachycardia. Rarely, bradycardia. Gastrointestinal disorders: Nausea. Rarely, ileus. Immune system disorders: Allergic reaction. Investigations: Rarely, transient increase in liver enzymes. Nervous system disorders: Headache, dizziness. Skin and subcutaneous tissue disorders: Rash. Vascular disorders: Vasodilatation.
Closely monitor blood pressure and heart rate. Assess for signs and symptoms of new heart failure.
Overdosage
Symptoms: Excessive peripheral vasodilation with marked systemic hypotension, tachycardia, bradycardia, gastrointestinal complaints and nausea (after oral ingestion). Management: Symptomatic and supportive treatment. May perform gastric lavage with the addition of charcoal as an emergency measure. Administration of vasopressors (e.g. dopamine, norepinephrine) may be considered if significant hypotension occurs.
Drug Interactions
Increased plasma concentration with CYP3A4 inhibitors (e.g. clarithromycin, erythromycin, ritonavir, ketoconazole, quinupristin + dalfopristin, nefazodone, fluoxetine, cimetidine, valproic acid). Enhanced hypotensive effect with other Ca-channel blockers, α-adrenergic blockers, ACE inhibitors, ARBs, β-blockers, diuretics, methyldopa, and Phosphodiesterase-5 (PDE5) inhibitors. May cause renal function deterioration with nephrotoxic agents (e.g. furosemide, aminoglycosides, cephalosporin). Potentially Fatal: Decreased efficacy with rifampicin and anti-epileptic drugs (e.g. carbamazepine, phenobarbital, phenytoin).
Food Interaction
Increased plasma concentration with grapefruit juice; avoid concomitant use. Decreased plasma concentration and efficacy with St. John's wort.
Lab Interference
May cause a false-negative aldosterone/renin ratio (ARR).
Action
Description: Mechanism of Action: Nimodipine is a selective dihydropyridine Ca-channel blocker with a particular effect on cerebral blood vessels perhaps due to its high lipophilicity. Its mechanism of action in subarachnoid haemorrhage has not been fully determined; however, it appears to dilate small cerebral resistance vessels which results in increased collateral circulation. It also prevents the influx of extracellular Ca ions to the slow channels or select voltage-sensitive areas of vascular smooth muscle and myocardium during depolarisation thereby causes inhibition of vascular smooth muscle contractions. Pharmacokinetics: Absorption: Rapidly and practically completely absorbed from the gastrointestinal tract. Food may decrease the extent of absorption. Bioavailability: Approx 5-15%. Time to peak plasma concentration: Within 1 hour. Distribution: Crosses the blood-brain barrier (with lower concentrations in CSF than in plasma) and placenta and enters breast milk. Plasma protein binding: >95%. Metabolism: Extensively metabolised in the liver via dehydrogenation of the dihydropyridine ring and oxidative O-demethylation by CYP3A4 isoenzyme; undergoes extensive first-pass metabolism. Excretion: Via urine (<1% as unchanged drug); faeces. Elimination half-life: 1-2 hours.
Chemical Structure
Nimodipine Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 4497, Nimodipine. https://pubchem.ncbi.nlm.nih.gov/compound/Nimodipine. Accessed Mar. 26, 2024.
Storage
Tab/cap/oral solution: Store between 20-25°C. Protect from light. Do not freeze the cap. Do not refrigerate the oral solution. Intact vial: Store below 25°C. Protect from light.
C08CA06 - nimodipine ; Belongs to the class of dihydropyridine derivative selective calcium-channel blockers with mainly vascular effects. Used in the treatment of cardiovascular diseases.
References
Anon. Nimodipine. AHFS Clinical Drug Information [online]. Bethesda, MD. American Society of Health-System Pharmacists, Inc. https://www.ahfscdi.com. Accessed 20/02/2024.Anon. Nimodipine. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 20/02/2024.Bayer New Zealand Limited. Nimotop 10 mg/50 mL Concentrated Intravenous Infusion Solution and 30 mg Tablet data sheet 30 June 2023. Medsafe. http://www.medsafe.govt.nz. Accessed 20/02/2024.Buckingham R (ed). Nimodipine. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 20/02/2024.Joint Formulary Committee. Nimodipine. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 20/02/2024.Nimodipine Capsule, Liquid Filled (Biopharma Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 20/02/2024.Nimodipine. Gold Standard Drug Database in ClinicalKey [online]. Elsevier Inc. https://www.clinicalkey.com. Accessed 19/03/2024.Nimotop 0.02% Solution for Infusion (Bayer plc). MHRA. https://products.mhra.gov.uk. Accessed 20/02/2024.Nimotop 30 mg Tablets (Bayer plc). MHRA. https://products.mhra.gov.uk. Accessed 20/02/2024.Nimotop 30 mg Tablets (Bayer). MIMS Hong Kong. http://www.mims.com/hongkong. Accessed 20/02/2024.Nimotop Solution for Infusion 10 mg (50 mL) (Bayer Co. [Malaysia] Sdn. Bhd.). National Pharmaceutical Regulatory Agency - Ministry of Health Malaysia. https://www.npra.gov.my. Accessed 20/02/2024.Nymalize Solution (Azurity Pharmaceuticals, Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 20/02/2024.Paediatric Formulary Committee. Nimodipine. BNF for Children [online]. London. BMJ Group, Pharmaceutical Press, and RCPCH Publications. https://www.medicinescomplete.com. Accessed 20/02/2024.
Sign Out
