Drug Detail:Nimodipine (Nimodipine [ nih-mo-dih-peen ])
Drug Class: Calcium channel blocking agents
Usual Adult Dose for Subarachnoid Hemorrhage
60 mg orally, nasogastric, or gastric tube every 4 hours
- Duration of therapy: 21 days
Comments:
- Treatment should begin within 96 hours of the onset of subarachnoid hemorrhage (SAH).
- IV and other parenteral routes should be avoided.
Use: Improvement of neurological outcome by reducing the incidence and severity of ischemic deficits in patients with SAH from ruptured intracranial berry aneurysms regardless of their post ictus neurological conditions (e.g., Hunt and Hess Grades I to V)
Renal Dose Adjustments
Data not available
Liver Dose Adjustments
Patients with cirrhosis: 30 mg orally every 4 hours
Comments:
- Blood pressure and heart rate should be monitored closely during treatment.
- If necessary, discontinuation may be considered.
Dose Adjustments
Concomitant use with strong CYP450 3A4 inducers/inhibitors: Avoid use.
Concomitant use with moderate/weak CYP450 3A4 inducers: Monitor for effectiveness; an increase in the dose of this drug may be considered.
Concomitant use with moderate/weak CYP450 3A4 inhibitors: Consider reducing the dose of this drug if hypotension occurs.
Precautions
US BOXED WARNINGS:
DEATH DUE TO INADVERTENT INTRAVENOUS ADMINISTRATION:
- Do not administer capsule formulations intravenously or by other parenteral routes.
- Deaths and serious, life threatening adverse events, including cardiac arrest, cardiovascular collapse, hypotension, and bradycardia, have occurred when the contents of capsule formulations have been injected parenterally.
Safety and efficacy have not been established in patients younger than 18 years.
Consult WARNINGS section for additional precautions.
Dialysis
Data not available
Other Comments
Administration advice:
- For all oral routes, this drug should be given 1 hour before OR 2 hours after a meal.
- Alkaline mixtures should be avoided before/after administrating oral tablet formulations.
- Oral formulations of this drug should be limited to enteral routes (e.g. oral, nasogastric tube, gastric tube).
- After nasogastric or gastric tube administration, the syringe should be rinsed with 20 to 30 mL of 0.9% saline solution to flush remaining contents from the nasogastric or gastric tube into the stomach.
- Intravenous nimodipine may be administered during anesthesia or surgical procedures.
Storage requirements:
- Capsule formulations: Protect from light and freezing.
- Oral solution formulations: Protect from light; do not refrigerate.
- Oral tablet formulations: Protect from moisture and light.
- Parenteral formulations: Protect from light and freezing.
Reconstitution/preparation techniques:
- For those unable to swallow a capsule, oral administration may be achieved by using a syringe to extract the gel inside the capsule, then administering the gel into the patient's nasogastric tube or G-tube.
IV compatibility:
- The manufacturer product information should be consulted.
General:
- Grapefruit juice should be avoided during treatment.
- Treatment for traumatic subarachnoid hemorrhage is not recommended as a positive benefit has not been established.
Monitoring:
- Cardiovascular: Blood pressure, heart rate
Patient advice:
- Inform patients that this drug may cause dizziness, and they should avoid driving or operating machinery if these side effects occur.
- Advise patients to speak to their healthcare provider if they become pregnant, intend to become pregnant, or are breastfeeding.
- Patients should be instructed to avoid grapefruit juice during treatment.
