Nimodipine
Classification
Dihydropyridine, calcium channel blocker
Indications
CCP: Subarachnoid hemorrhage
Contraindications
- Hypersensitivity
- Concomitant use with phenobarbital, phenytoin, carbamazepine, or rifampin
- Concomitant use with strong CYP3A4 inhibitors
Adult dosages
CCP: Intracranial hemorrhage
- 60 mg PO q 4 hours
Pediatric Considerations And Dosing
- No data for pediatric use.
How Supplied
Not supplied by BCEHS
Tablet 30 mg
Mechanism Of Action
Nimodipine shares the pharmacology of other calcium channel blockers but with a greater affinity on cerebral arterials than other arterials. This increased specificity may be due to the drug's increased lipophilicity and cerebral distribution as compared to nifedipine. Nimodipine inhibits calcium ions from entering the “slow channels” or select voltage sensitive areas of vascular smooth muscle and myocardium during depolarization.
Pharmacokinetics
Time to peak: 0.25-1.05 hours
Half-life: 1-2 hours
Adverse Effects
Cardiovascular
- Decreased blood pressure, bradycardia, hypertension, palpitations
Hematological
- Anemia, decreased platelet count,
- DIC, hematoma, thrombocytopenia
Central nervous system
- Headache, dizziness
Dermatological
- Diaphoresis, flushing, edema, pruritus
Gastrointestinal
- Nausea, vomiting
- Gastrointestinal hemorrhage, gastrointestinal pseudo-obstruction, intestinal obstruction
Hepatic
- Hepatitis, increased lactate dehydrogenase, increased serum alkaline phosphatase, increased serum ALT, jaundice
Warning And Precautions
- Increased angina and/or MI have occurred with initiation or dosage titration of dihydropyridine calcium channel blockers.
- Reflex tachycardia may occur resulting in angina and/or MI in patients with obstructive coronary disease.
- Use with caution in patients with cirrhosis due to the increased plasma concentrations of nimodipine and an increased risk of adverse reactions.
- Use with caution in patients with hypertrophic cardiomyopathy with outflow tract obstruction.
- Nimodipine has inadvertently been administered IV when withdrawn from capsules into a syringe for subsequent nasogastric administration. Severe cardiovascular adverse events, including fatalities, have resulted.
Drug Interactions
- Abametapir
- Alfuzosin
- Alpha1-Blockers
- Amifostine
- Amphetamines
- Antipsychotic Agents (Second Generation [Atypical])
- Aprepitant
- Atosiban
- Barbiturates
- Benperidol
- Brigatinib
- Brimonidine (Topical)
- Bromperidol
- Calcium Salts
- Cimetidine
- Cladribine
- Clofazimine
- Clopidogrel
- CycloSPORINE (Systemic)
- CYP3A4 Inducers (Moderate)
- CYP3A4 Inducers (Strong)
- CYP3A4 Inducers (Weak)
- CYP3A4 Inhibitors (Moderate)
- CYP3A4 Inhibitors (Strong)
- CYP3A4 Inhibitors (Weak)
- Dantrolene
- Dapoxetine
- Deferasirox
- Dexmethylphenidate
- Diazoxide
- DULoxetine
- Erdafitinib
- Erdafitinib
- Fexinidazole
- FLUoxetine
- Fosaprepitant
- Fusidic Acid (Systemic)
- Grapefruit Juice
- Herbal Products with Blood Pressure Increasing Effects
- Herbal Products with Blood Pressure Lowering Effects
- Hypotension-Associated Agents
- Ivosidenib
- Levodopa-Containing Products
- Lormetazepam
- Magnesium Sulfate
- Melatonin
- Methylphenidate
- Molsidomine
- Naftopidil
- Neuromuscular-Blocking Agents (Nondepolarizing
- Nicergoline
- Nicorandil
- Nitroprusside
- Obinutuzumab
- Pentoxifylline
- Pholcodine
- Phosphodiesterase 5 Inhibitors
- Prostacyclin Analogues
- Quinagolide
- Sarilumab
- Siltuximab
- Simeprevir
- Sincalide
- St John's Wort
- Tacrolimus (Systemic
- Tocilizumab