Class: Calcium channel blocking agent
- Capsules, liquid 30 mg
Inhibits movement of calcium ions across cell membrane in systemic and coronary vascular smooth muscle and myocardium. Has greater effect on cerebral arteries than on other arteries.
Nimodipine is rapidly absorbed after oral administration. Bioavailability is 13% and T max is approximately 1 h. Food decreases peak plasma concentration 68% and bioavailability 38%.
Nimodipine protein binding is over 95%.
Extensive first-pass metabolism in the liver.
Nimodipine is eliminated in urine (less than 1% unchanged), and metabolites are considerably less active than parent compound. Terminal t 1/ 2 is 8 to 9 h, and initial t 1/ 2 is 1 to 2 h.
AUC and C max were approximately 2–fold higher; this response is not considered important.Hepatic Function Impairment
Nimodipine bioavailability is increased, C max almost doubles, and dosage adjustment is necessary in patients with hepatic cirrhosis.
Indications and Usage
Improvement of neurologic deficits caused by vasospasm after subarachnoid hemorrhage from ruptured intracranial berry aneurysms.
Dosage and AdministrationHepatic Cirrhosis
PO/Nasogastric Reduce dosage to 30 mg every 4 h.Subarachnoid Hemorrhage
PO/Nasogastric 60 mg every 4 h for 21 consecutive days. Initiate therapy within 96 h of subarachnoid hemorrhage.
- If capsule cannot be swallowed, make hole in both ends of capsule with 18-gauge needle and extract contents into syringe. Empty contents into patient's nasogastric tube and wash down tube with 30 mL of isotonic sodium chloride solution.
- Take 1 h before or 2 h after meals.
Store at room temperature (59° to 86°F) in original foil packaging.
May cause increased adverse reactions because of myocardial contractility or AV conduction depression.Cimetidine, grapefruit juice
Nimodipine plasma levels may be elevated, increasing the pharmacologic effects and adverse reactions.Fentanyl
May cause severe hypotension or increased fluid requirements.Other hypertensive agents
May have additive effects.
Laboratory Test Interactions
None well documented.
Hypotension (4%); bradycardia, ECG abnormalities, tachycardia (1%); CHF, heart failure, hypertension, palpitations, rebound vasospasm (less than 1%).
Headache (4%); depression (1%); dizziness, light-headedness (less than 1%).
Rash (2%); acne (1%); diaphoresis, itching (less than 1%).
Diarrhea (4%); GI symptoms (2%); nausea (1%); GI hemorrhage; vomiting (less than 1%).
Anemia, decreased platelet count, deep vein thrombosis, DIC, hematoma, thrombocytopenia (less than 1%).
Abnormal LFTs (1%); hepatitis, jaundice (less than 1%).
Hyponatremia (less than 1%).
Muscle cramps/pain (1%).
Dyspnea (1%); wheezing (less than 1%).
Flushing (2%); edema (1%); phenytoin toxicity (less than 1%).
Death and serious, life-threatening adverse reactions have occurred when the contents of nimodipine capsules have been injected parenterally. Do not administer IV or by other parenteral routes.
Carefully monitor BP during treatment. In patients with hepatic cirrhosis, closely monitor BP and heart rate.
Category C .
Safety and efficacy not established.
Use with caution, reflecting greater frequency of decreased hepatic, renal, or cardiac function, and concomitant disease or other drug therapy.
Use drug with caution in patients with hepatic function impairment or reduced hepatic blood flow.
Calcium channel blockers may inhibit platelet function.
Symptoms of overdosage have not been reported. Symptoms would be expected to be related to CV effects such as excessive peripheral vasodilation with marked systemic hypotension.
- Explain that medication needs to be taken around the clock for 21 days.
- Instruct patient to report the following symptoms to health care provider: abdominal cramping, diarrhea, dizziness, faint feeling, nausea, palpitations, shortness of breath, swelling of hands or feet, unusual bruising or bleeding.
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