Formulary
Nimodipine: Indications, Dosing, Side Effects and Interactions
For all calcium-channel blockers Calcium-channel blockers (less correctly called 'calcium-antagonists') interfere with the inward displacement of calcium ions...
MedNext Academy | 5 min read
Nimodipine: Indications, Dosing, Side Effects and Interactions
For all calcium-channel blockers Calcium-channel blockers (less correctly called 'calcium-antagonists') interfere with the inward displacement of calcium ions...
Drug action
For all calcium-channel blockers Calcium-channel blockers (less correctly called 'calcium-antagonists') interfere with the inward displacement of calcium ions through the slow channels of active cell membranes. They influence the myocardial cells, the cells within the specialised conducting system of the heart, and the cells of vascular smooth muscle. Thus, myocardial contractility may be reduced, the formation and propagation of electrical impulses within the heart may be depressed, and coronary or systemic vascular tone may be diminished. Drug action For nimodipine Nimodipine is a dihydropyridine calcium-channel blocker.
Indications and dose
**Prevention of ischaemic neurological defects following aneurysmal subarachnoid haemorrhage**
- **Adult** (By Mouth): 60 mg every 4 hours, to be started within 4 days of aneurysmal subarachnoid haemorrhage and continued for 21 days.
**Treatment of ischaemic neurological defects following aneurysmal subarachnoid haemorrhage**
- **Adult** (By Intravenous Infusion): (body-weight 70 kg and above) Initially 1 mg/hour, increased after 2 hours if no severe fall in blood pressure; increased to 2 mg/hour and continue for at least 5 days (max. 14 days); if surgical intervention during treatment, continue for at least 5 days after surgery; max. total duration of nimodipine use 21 days, to be given via central catheter.
**Treatment of ischaemic neurological defects following aneurysmal subarachnoid haemorrhage in patients with unstable blood pressure**
- **Adult** (By Intravenous Infusion): Initially up to 0.5 mg/hour, increased after 2 hours if no severe fall in blood pressure; increased to 2 mg/hour and continue for at least 5 days (max. 14 days); if surgical intervention during treatment, continue for at least 5 days after surgery; max. total duration of nimodipine use 21 days, to be given via central catheter.
**Treatment of vasospasm following subarachnoid haemorrhage (specialist use only) for nimodipine**
- **Child 1 month-11 years** (By intravenous infusion): Initially 15 micrograms/kg/hour (max. per dose 500 micrograms/hour), increased after 2 hours if no severe decrease in blood pressure; increased to 30 micrograms/kg/hour (max. per dose 2 mg/hour), continue for at least 5 days (max. 14 days), use initial dose of 7.5 micrograms/kg/hour if blood pressure unstable.
- **Child 12-17 years (body-weight up to 70 kg)** (By intravenous infusion): Initially 0.5 mg/hour, increased after 2 hours if no severe decrease in blood pressure; increased to 1-2 mg/hour, continue for at least 5 days (max. 14 days).
- **Child 12-17 years (body-weight 70 kg and above)** (By intravenous infusion): Initially up to 1 mg/hour, use dose if blood pressure stable; increased after 2 hours if no severe decrease in blood pressure; increased to 1-2 mg/hour, continue for at least 5 days (max. 14 days).
**Prevention of vasospasm following subarachnoid haemorrhage for nimodipine**
- **Child** (By mouth): 0.9-1.2 mg/kg 6 times a day (max. per dose 60 mg), started within 4 days of haemorrhage and continued for 21 days.
Cautions
For all calcium-channel blockers Elderly Cautions, further information Elderly Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) criteria to aid medication reviews (see Prescribing in the elderly for information): potentially inappropriate with persistent postural hypotension i.e. recurrent drop in systolic blood pressure 20 mmHg (risk of syncope and falls). Cautions For nimodipine Cerebral oedema; hypotension; severely raised intracranial pressure
Contraindications
Unstable angina; within 1 month of myocardial infarction
Side effects
For all calcium-channel blockers Common or very common Abdominal pain; dizziness; drowsiness; fatigue; flushing; headache; hypotension; nausea; palpitations; peripheral oedema; skin reactions; tachycardia; vomiting Uncommon Angioedema; depression; erectile dysfunction; gingival hyperplasia; myalgia; paraesthesia; syncope Overdose Features of calcium-channel blocker poisoning include nausea, vomiting, dizziness, agitation, confusion, and coma in severe poisoning. Metabolic acidosis and hyperglycaemia may occur. In overdose, the dihydropyridine calcium-channel blockers cause severe hypotension secondary to profound peripheral vasodilatation. For details on the management of poisoning, see Calcium-channel blockers, under Emergency treatment of poisoning. Side-effects For nimodipine Uncommon Thrombocytopenia; vasodilation Rare or very rare Bradycardia; ileus
Interactions
**Other interactions (15):**
- Drugs that affect nimodipine Concurrent twice daily administration of 30mg nimodipine and daily administration of 20mg of the antidepressant fluoxetine to elderly patients resulted in about 50%...
- Concurrent three times daily administration of 30mg nimodipine and three times daily administration of 10mg of the antidepressant nortriptyline to elderly patients resulted in a slight decrease in...
- Nimodipine is metabolised via the cytochrome P450 3A4 system, located both in the intestinal mucosa and in the liver.
- Although no formal interaction studies have been performed to investigate the potential interaction between nimodipine and inhibitors of cytochrome P450 3A4, the potential for drug interaction and...
- Upon co-administration with the following inhibitors of the cytochrome P450 3A4 system the blood pressure should be monitored and, if necessary, an adaption in the nimodipine dose should be...
- Effects of nimodipine on other drugs Blood pressure lowering drugs Nimodipine may increase the blood pressure lowering effect of concomitant antihypertensives, such as: - diuretics, - beta-blockers,...
Pregnancy
Manufacturer advises use only if potential benefit outweighs risk.
Breast feeding
Manufacturer advises avoid-present in milk.
Hepatic impairment
For all calcium-channel blockers In general, manufacturers advise caution (risk of increased exposure). Hepatic impairment For nimodipine With oral use: Manufacturer advises consider avoiding in severe impairment. Dose adjustments With oral use: Manufacturer advises dose reduction, if used in severe impairment.
Medicinal forms
Suspension,Tablet,Solution
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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