nimodipine

Inhibits the transport of calcium into vascular smooth muscle cells, resulting in inhibition of excitation-contraction coupling and subsequent contraction.
Potent peripheral vasodilator.

Therapeutic effects:

Prevention of vascular spasm after subarachnoid hemorrhage, resulting in decreased neurologic impairment.

Pharmacokinetics ⬆ ⬇

Absorption: Well absorbed following oral administration but undergoes first-pass metabolism, resulting in ↓ bioavailability.

Distribution: Crosses the blood-brain barrier; remainder of distribution unknown.

Protein Binding: >95%.

Metabolism/Excretion: Mostly metabolized by the liver; ≤10% excreted unchanged by kidneys.

Half-Life: 1–2 hr.

Time/Action Profile ⬆ ⬇

(vasodilation)

ROUTE	ONSET	PEAK	DURATION
PO	unknown	1 hr	4 hr

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity;
Systolic BP <90 mm Hg.

Use Cautiously in:

Severe hepatic impairment (dose ↓ recommended);
Severe renal impairment;
History of serious ventricular arrhythmias or HF;
OB: Safety not established in pregnancy;
Lactation: Safety not established in breastfeeding;
Pedi: Safety and effectiveness not established in children;
Geri: Dose recommended in older adults due to risk of hypotension.

Adv. Reactions/Side Effects ⬆ ⬇

CV: ARRHYTHMIAS, chest pain, HF, hypotension, palpitations, peripheral edema, syncope, tachycardia

Derm: ↑sweating, dermatitis, ERYTHEMA MULTIFORME, flushing, photosensitivity, pruritus/urticaria, rash, STEVENS-JOHNSON SYNDROME (SJS)

EENT: blurred vision, disturbed equilibrium, epistaxis, tinnitus

Endo: gynecomastia, hyperglycemia

GI: ↑liver enzymes, anorexia, constipation, diarrhea, dry mouth, dyspepsia, nausea, vomiting

GU: dysuria, nocturia, polyuria, sexual dysfunction, urinary frequency

Hemat: anemia, leukopenia, thrombocytopenia

Metab: ↑weight

MS: joint stiffness, muscle cramps

Neuro: abnormal dreams, anxiety, confusion, dizziness, drowsiness, dysgeusia, headache, nervousness, paresthesia, psychiatric disturbances, tremor, weakness

Resp: cough, dyspnea

Misc: gingival hyperplasia

Interactions ⬆ ⬇

Drug-drug:

Strong CYP3A4 inhibitors, including clarithromycin, nelfinavir, ritonavir, ketoconazole, itraconazole, posaconazole, voriconazole, conivaptan, and nefazodone, may ↑ levels and the risk of hypotension; avoid concurrent use
Strong CYP3A4 inducers, including carbamazepine, phenobarbital, phenytoin, and rifampin, may ↓ levels and effectiveness; avoid concurrent use.
Additive hypotension may occur when used concurrently with fentanyl, other antihypertensives, nitrates, acute ingestion of alcohol, or quinidine.

Drug-Natural Products:

St. John's wort may ↓ levels and effectiveness; avoid concurrent use

Grapefruit and grapefruit juice may ↑ levels and the risk of toxicity; avoid concurrent use.

Route/Dosage ⬆ ⬇

PO (Adults ): 60 mg every 4 hr for 21 days; therapy should be started within 96 hr of subarachnoid hemorrhage.

Hepatic Impairment

PO (Adults ): Severe hepatic impairment: 30 mg every 4 hr for 21 days; therapy should be started within 96 hr of subarachnoid hemorrhage.

Availability ⬆ ⬇

(Generic available)

Capsules: 30 mg
Oral solution: 6 mg/mL

Assessment ⬆ ⬇

Assess patient’s neurologic status (level of consciousness, movement) prior to and periodically following administration.
Monitor BP and pulse prior to therapy and periodically during therapy.
Monitor intake and output ratios and daily weight. Assess for signs of HF (peripheral edema, rales/crackles, dyspnea, weight gain, jugular venous distention).
Assess for rash periodically during therapy. May cause SJS. Discontinue therapy if severe or if accompanied with fever, general malaise, fatigue, muscle or joint aches, blisters, oral lesions, conjunctivitis, hepatitis, and/or eosinophilia.

Lab Test Considerations:

Total serum calcium concentrations are not affected by calcium channel blockers.
- Monitor serum potassium periodically. Hypokalemia↑ risk of arrhythmias; should be corrected.
- Monitor renal and hepatic functions periodically. Several days of therapy may cause ↑ hepatic enzymes, which return to normal upon discontinuation of therapy.
- May occasionally cause ↓ platelet count.

Implementation ⬆ ⬇

Do not confuse nimodipine with nicardipine or nifedipine.
- Begin administration within 96 hr of subarachnoid hemorrhage and continue every 4 hr for 21 consecutive days.
Administer by PO route ONLY; administration via IV or parenterally, may cause serious adverse events, including death.
PO: If patient is unable to swallow capsule, make a hole in both ends of the capsule with a sterile 18-gauge needle and extract the contents into a syringe. Empty contents into water or nasogastric tube and flush with 30 mL normal saline.
- Administer oral solution 1 hr before or 2 hr after meals. For administration via nasogastric (NG) or gastric tube, administer via syringe included, then refill syringe with 20 mL of 0.9% saline water solution; flush remaining contents from NG or gastric tube into stomach.

Patient/Family Teaching ⬆ ⬇

Advise patient to take medication as directed, even if feeling well. Take missed doses as soon as possible unless almost time for next dose; do not double doses. May need to be discontinued gradually.
- Advise patient to avoid grapefruit or grapefruit juice during therapy.
- Caution patient to change positions slowly to minimize orthostatic hypotension.
- May cause drowsiness or dizziness. Advise patient to avoid driving or other activities requiring alertness until response to the medication is known.
- Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to avoid concurrent use of alcohol or OTC medications and herbal products, especially cold preparations, without consulting health care professional.
- Advise patient to notify health care professional if rash, irregular heartbeat, dyspnea, swelling of hands and feet, pronounced dizziness, nausea, constipation, or hypotension occurs or if headache is severe or persistent.
- Caution patient to wear protective clothing and use sunscreen to prevent photosensitivity reactions.
Rep: Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding.

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇