Nimodipine

Indications

Nimodipine is used for: Subarachnoid haemorrhage, Stroke prevention

Adult Dose

Oral Prophylaxis of neurological deficit following subarachnoid haemorrhage Adult: 60 mg 4 hrly beginning w/in 4 days of onset of haemorrhage and continued for 21 consecutive days. Hepatic impairment: Initially, 30 mg 4 hrly.

Child Dose

Renal Dose

Administration

Cap: Should be taken on an empty stomach. Take on an empty stomach 1 hr before or 2 hr after meals. Tab: May be taken with or without food. Take consistently, either always w/ or always w/o meals.

Contra Indications

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).

Precautions

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 and renal impairment. Pregnancy and lactation. Monitoring Parameters Careful monitoring of BP and pulse rate. Lactation: unknown; avoid

Pregnancy-Lactation

Interactions

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).

Adverse Effects

Side effects of Nimodipine : 1-10% Reduction in systemic blood pressure (1-8%), Diarrhea (2-4%), Headache (1-4%), Abdominal discomfort (2%), Rash (1-2%) <1% Heart failure, Arrhythmia, Anemia, ECG abnormalities, GI hemorrhage, Hepatitis, Jaundice, Thrombocytopenia, Vomiting, Thrombosis, Rebound vasospasm Potentially Fatal: Angina/MI, symptomatic hypotension.

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.