Nimodipine info?

Nimodipine is a calcium channel blocker (dihydropyridine) that mainly dilates cerebral arteries. It’s used to reduce brain damage after aneurysmal subarachnoid hemorrhage (SAH) by helping prevent cerebral vasospasm.

Key points

- Indication
- Specifically used after aneurysmal SAH to reduce poor outcomes from vasospasm. Not for general hypertension or other types of stroke.

- How it works
- Blocks L-type calcium channels in vascular smooth muscle, with a preference for cerebral vessels, reducing vasospasm.

- Dosing (adults)
- Nimodipine oral capsules: 60 mg every 4 hours for 21 days.
- Since capsules are usually 30 mg, this means two capsules per dose.
- Start as soon as possible after SAH and within about 96 hours if possible.

- Important administration notes
- Take capsules swallowed whole with water. Do not chew or crush.
- Do not give nimodipine by IV or intra-arterial route. IV nimodipine is dangerous and should be avoided; there is a risk of severe hypotension and death if given IV.
- If vomiting occurs soon after a dose, consult care guidelines; do not double-dose at the next administration without medical advice.

- Contraindications and cautions
- Hypotension or significant low blood pressure.
- Known hypersensitivity to nimodipine or other dihydropyridine calcium channel blockers.
- Caution in severe hepatic impairment (metabolism is hepatic).
- Interactions with strong CYP3A4 inhibitors (eg, ketoconazole, itraconazole, ritonavir, clarithromycin) or inducers (eg, rifampin) can markedly affect nimodipine levels.
- Avoid grapefruit juice and other strong CYP3A4-modifying foods/drugs.

- Common side effects
- Headache, dizziness, flushing.
- Hypotension or lightheadedness.
- Nausea, edema.

- Pregnancy and nursing
- Category C; use only if clearly needed and benefits outweigh risks. Discuss with a clinician if you’re pregnant or breastfeeding.

- Monitoring
- Regularly check blood pressure and heart rate (risk of hypotension).
- Monitor for signs of vasospasm improvement and any adverse effects.
- If hepatic disease is present, monitor liver function as advised by your clinician.

- Brand and formulations
- Common brand: Nimotop (varies by country; generics available).

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