• Subarachnoid hemorrhage.

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.

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.

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

Drug-Food:

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

(Generic available)

• Capsules: 30 mg;
• Oral solution: 6 mg/mL;

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

Nymalize

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

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

Therapeutic Classification:subarachnoid hemorrhage therapy agents

Pharmacologic Classification: calcium channel blockers

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.

Nimotop

(vasodilation)

• 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.
• Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding.

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