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
Indication
Subarachnoid haemorrhage, Stroke prevention
Contra Indication
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).
Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks
Mode 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.
Interaction
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).
Pregnancy Category Note
N/A
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
N/A
Renal Dose
N/A
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.
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