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Nimodipine

Class
Vasoactive agents
Subclass
Dihydropyridine calcium channel blockers
Generic name
niMODipine
Brand names
Nymalize®
Common formulations
Solution, Capsule
Dosage and administration
Adults patients
Treatment of subarachnoid hemorrhage • Hunt and Hess Grades I-V
•
60 mg PO q4h for 21 days
Administer within 96 hours of subarachnoid hemorrhage. Swallow capsules whole with a little liquid, preferably not less than one hour before or two hours after meals. Avoid with grapefruit juice.
Other off-label uses
•
Adjunctive treatment for dementia
Indications for use
Labeled indications
Adults
•
Treatment of subarachnoid hemorrhage (hunt and Hess Grades I-V)
Off-label indications
Adults
•
Adjunctive treatment for dementia
Safety risks
Boxed warnings
Death, cardiac arrest, bradycardia
Contraindications
Hypersensitivity to nimodipine or its components
Pre-existing low SBP
Strong inhibitors of CYP3A4 such as some macrolide antibiotics (e.g., clarithromycin, telithromycin), some anti-HIV protease inhibitors (e.g., delaviridine, indinavir, nelfinavir, ritonavir, saquinavir), some azole antimycotics (e.g., ketoconazole, itraconazole, voriconazole) and some antidepressants (e.g., nefazadone)
Warnings and precautions
Hypotension
•
Use caution in patients with hepatic dysfunction.
Ileus
•
Maintain a high level of suspicion for these rare adverse events, manage conservatively.
Specific populations
Renal impairment
eGFR 0-90 mL/min/1.73 m²
•
Use acceptable. No dose adjustment required. Monitor renal function.
Renal replacement therapy
Any modality
•
Use acceptable. No dose adjustment required.
Hepatic impairment
Acute or decompensated chronic liver disease
•
Reduce dose. Reduce dose by 50%. Maximal dose of 30 mg every 4 hours for 21 consecutive days for subarachnoid hemorrhage. Monitor for toxicity.
Pregnancy and breastfeeding
Pregnancy
All trimesters • Australia Category: C
•
Use only if benefits outweigh potential risks. Evidence of fetal harm in animals.
Breastfeeding
Use only if benefits outweigh potential risks.
Unknown drug levels in breastfed infants.
Adverse reactions
Common 1-10%
•
Bradycardia, hypotension, headache, nausea
Uncommon < 1%
•
Muscle cramps
Unknown frequency
•
Cancer, cardiac arrest, diaphoresis, gastrointestinal bleeding, heart failure, hepatitis, ↑ liver enzymes, ↑ liver enzymes, jaundice, low oxygen levels, peripheral edema, peripheral vasodilation, bleeding tendency, fatigue, generalized pruritus, myalgia, skin rash, syncope
Interactions
Drug(s)
Check Interactions
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