Nimodipine

What it is and how it works

Mechanism of Action Nimodipine is a dihydropyridine calcium channel blocker. The contractile processes of smooth muscle cells are dependent upon calcium ions, which enter these cells during depolarization as slow ionic transmembrane currents. Nimodipine inhibits calcium ion transfer into these cells and thus inhibits contractions of vascular smooth muscle. In animal experiments, nimodipine had a greater effect on cerebral arteries than on arteries elsewhere in the body perhaps because it is highly lipophilic, allowing it to cross the blood-brain barrier; concentrations of nimodipine as high as 12.5 ng/mL have been detected in the cerebrospinal fluid of nimodipine-treated SAH patients.

Mechanism class: Calcium Channel Antagonists

Indications

Nimodipine oral solution is indicated for the improvement of neurological outcome by reducing the incidence and severity of ischemic deficits in adult patients with subarachnoid hemorrhage (SAH) from ruptured intracranial berry aneurysms regardless of their post-ictus neurological condition (i.e., Hunt and Hess Grades I to V). Nimodipine oral solution is a dihydropyridine calcium channel blocker indicated for the improvement of neurological outcome by reducing the incidence and severity of ischemic deficits in adult patients with subarachnoid hemorrhage (SAH) from ruptured intracranial berry aneurysms regardless of their post-ictus neurological condition (i.e., Hunt and Hess Grades I to V).

Dosage and administration (summary)

• Administer only enterally (e.g., oral, nasogastric tube, or gastric tube route). Do not administer intravenously or by other parenteral routes. • Give one hour before a meal or two hours after a meal. • Start dosing within 96 hours of the SAH. • Recommended dose is 20 mL (60 mg) every 4 hours for 21 consecutive days. • Nasogastric or Gastric Tube Administration: Administer 20 mL (60 mg) every 4 hours with an oral syringe. Refill syringe with 20 mL of 0.9% saline water solution; flush remaining contents from nasogastric or gastric tube into stomach. • Patients with Cirrhosis: Reduce dosage to 10 mL (30 mg) every 4 hours.

Contraindications

None. None

Warnings and precautions

Hypotension: Monitor blood pressure. • Patients with Cirrhosis: Higher risk of adverse reactions. Monitor blood pressure and pulse. • CYP3A4 Strong Inhibitors: May significantly increase risk of hypotension. Concomitant use with nimodipine should generally be avoided. • CYP3A4 Strong Inducers: May significantly reduce efficacy of nimodipine. Concomitant use with nimodipine should generally be avoided. Hypotension Blood pressure should be carefully monitored during treatment with nimodipine.

Pregnancy

Pregnancy Risk Summary There are no adequate data on the developmental risk associated with the use of nimodipine in pregnant women. In animal studies, oral administration of nimodipine during pregnancy resulted in adverse effects on development (increased embryofetal mortality, increased incidences of fetal structural abnormalities, decreased feta…

Storage and supply

Nimodipine Oral Solution 3 mg/mL is a pale yellow solution and is supplied as follows: · NDC 31722-039-47: 16 oz. bottle (473 mL) 60 mg/20 mL (3 mg/mL). Store between 20°C to 25°C (68°F to 77°F); excursions permitted to 15°C to 30°C (59°F to 86°F). . Protect from light. Do not refrigerate.

Source: Nimodipine (Nimodipine) — US FDA prescribing information, 2024-07-20, DailyMed. Summarised and shortened; the full label governs. Iranian registration, indications and labelling may differ.