Nimodipine

By

Generic Name: Nimodipine Brand Name(s): Generics only. No brands available.

Uses

What is Nimodipine used for?

Nimodipine is used to decrease problems due to a certain type of bleeding in the brain (subarachnoid hemorrhage-SAH).

Nimodipine is called a calcium channel blocker. The body naturally responds to bleeding by narrowing the blood vessel to slow blood flow. However, when the bleeding is in the brain, stopping blood flow causes more brain damage. Nimodipine is thought to work by relaxing narrowed blood vessels in the brain near the area of bleeding so blood can flow more easily. This effect reduces brain damage.

How should I take Nimodipine?

Nimodipine is usually started as soon as possible after the start of bleeding in the brain, usually within 4 days. Nimodipine is usually taken every 4 hours or as directed by your doctor.

If you are taking the tablet form of this medication, take it by mouth with a full glass of water (8 ounces/240 milliliters) unless your doctor directs you otherwise. Do not lie down for 10 minutes after taking this medication. Swallow the tablet whole. Do not crush.

If you are taking the capsule form of this medication, take it by mouth at least 1 hour before and 2 hours after meals, or as directed by your doctor. Swallow the capsule whole. If you cannot swallow a whole capsule, you may poke a hole in the capsule, draw the liquid out with a syringe, and give it by mouth or through a nasogastric tube with an oral syringe. Do not mix the contents of the capsule with other liquids. Doing so may prevent the medication from working. Do not inject this medication.

If you are using the liquid form (oral solution) of this medication, carefully measure the dose using a special measuring device/spoon. Do not use a household spoon because you may not get the correct dose. Use the liquid form at least 1 hour before and 2 hours after meals. The liquid form may also be given through a tube into the stomach (nasogastric or gastric tube). If you are giving this medication through a nasogastric or gastric tube, ask your health care professional for detailed instructions on how to give it.

Do not take antacids for 2 hours before or after taking nimodipine tablets. Doing so may prevent the medication from working.

The dosage is based on your medical condition and response to treatment.

Use this medication regularly to get the most benefit from it. To help you remember, take it at the same times each day. It is important to continue taking this medication even if you feel well, and even if you do not see any improvement in your symptoms. Consult your doctor or pharmacist for details.

Do not suddenly stop taking this medication without consulting your doctor. This medication is usually taken for 2 to 4 weeks. Follow your doctor’s directions carefully. Your condition may become worse if the drug is stopped too soon.

Tell your doctor if your condition worsens.

How do I store Nimodipine?

Nimodipine is best stored at room temperature away from direct light and moisture. To prevent drug damage, you should not store Nimodipine in the bathroom or the freezer. There may be different brands of Nimodipine that may have different storage needs. It is important to always check the product package for instructions on storage, or ask your pharmacist. For safety, you should keep all medicines away from children and pets.

You should not flush Nimodipine down the toilet or pour them into a drain unless instructed to do so. It is important to properly discard this product when it is expired or no longer needed. Consult your pharmacist for more details about how to safely discard your product.

Precautions & warnings

What should I know before using Nimodipine?

Before taking nimodipine, tell your doctor or pharmacist if you are allergic to it; or to other dihydropyridine calcium channel blockers (such as amlodipine, nifedipine); or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before using this medication, tell your doctor or pharmacist your medical history, especially of: chest pain/recent heart attack, low blood pressure, recent head injury, liver disease.

This drug may make you dizzy. Alcohol or marijuana can make you more dizzy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana.

Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).

Older adults may be more sensitive to the side effects of this drug, especially dizziness, or swelling of ankles/feet. Dizziness can increase the risk of falling.

During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.

This medication passes into breast milk. Consult your doctor before breast-feeding.

Is it safe during pregnancy or breast-feeding?

There are no adequate studies in women for determining risk when using this Nimodipine during pregnancy or while breastfeeding. Please always consult with your doctor to weigh the potential benefits and risks before taking Nimodipine. Nimodipine is pregnancy risk category C according to the US Food and Drug Administration (FDA).

FDA pregnancy risk category reference below:

  • A=No risk,
  • B=No risk in some studies,
  • C=There may be some risk,
  • D=Positive evidence of risk,
  • X=Contraindicated,
  • N=Unknown

Side effects

What side effects can occur from Nimodipine?

Dizziness, lightheadedness, flushing, or swelling ankles/feet may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.

To reduce dizziness and lightheadedness, get up slowly when rising from a sitting or lying position.

Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

Tell your doctor right away if you have any serious side effects, including: fainting, slow/fast heartbeat, severe abdominal pain, stomach bloating, inability to have a bowel movement for more than 3 days, severe nausea/vomiting, vision changes.

A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

Not everyone experiences these side effects. There may be some side effects not listed above. If you have any concerns about a side-effect, please consult your doctor or pharmacist.

Interactions

What drugs may interact with Nimodipine?

Some products that may interact with this drug are: drugs for high blood pressure (such as beta blockers including propranolol and metoprolol, ACE inhibitors such as benazepril and enalapril), other calcium channel blockers (such as diltiazem, verapamil).

Other medications can affect the removal of nimodipine from your body, which may affect how nimodipine works. Examples include cimetidine, azole antifungals (such as itraconazole), macrolide antibiotics (such as erythromycin), rifamycins (such as rifabutin), St. John’s wort, drugs used to treat seizures (such as carbamazepine, phenytoin), among others.

Some products have ingredients that could raise your heart rate or blood pressure. Tell your pharmacist what products you are using, and ask how to use them safely (especially cough-and-cold products, diet aids, or NSAIDs such as ibuprofen/naproxen).

Nimodipine may interact with other drugs that you are currently taking, which can change how your drug works or increase your risk for serious side effects. To avoid any potential drug interactions, you should keep a list of all the drugs you are using (including prescription drugs, nonprescription drugs and herbal products) and share it with your doctor and pharmacist. For your safety, do not start, stop, or change the dosage of any drugs without your doctor’s approval.

Does food or alcohol interact with Nimodipine?

Nimodipine may interact with food or alcohol by altering the way the drug works or increase the risk for serious side effects. Please discuss with your doctor or pharmacist any potential food or alcohol interactions before using this drug.

Avoid eating grapefruit or drinking grapefruit juice while using this medication unless your doctor or pharmacist says you may do so safely. Grapefruit can increase the chance of side effects with this medicine. Ask your doctor or pharmacist for more details.

What health conditions may interact with Nimodipine?

Nimodipine may interact with your health condition. This interaction may worsen your health condition or alter the way the drug works. It is important to always let your doctor and pharmacist know all the health conditions you currently have.

Dosage

The information provided is not a substitute for any medical advice. You should ALWAYS consult with your doctor or pharmacist before using this Nimodipine.

What is the dose of Nimodipine for an adult?

Usual Adult Dose for Subarachnoid Hemorrhage

60 mg orally, nasogastric, or gastric tube every 4 hours

-Duration of therapy: 21 days

Comments:

-Treatment should begin within 96 hours of the onset of subarachnoid hemorrhage (SAH).

-IV and other parenteral routes should be avoided.

Use: Improvement of neurological outcome by reducing the incidence and severity of ischemic deficits in patients with SAH from ruptured intracranial berry aneurysms regardless of their post ictus neurological conditions (e.g., Hunt and Hess Grades I to V)

Liver Dose Adjustments

Patients with cirrhosis: 30 mg orally every 4 hours

Comments:

-Blood pressure and heart rate should be monitored closely during treatment.

-If necessary, discontinuation may be considered.

Dose Adjustments

Concomitant use with strong CYP450 3A4 inducers/inhibitors: Avoid use.

Concomitant use with moderate/weak CYP450 3A4 inducers: Monitor for effectiveness; an increase in the dose of this drug may be considered.

Concomitant use with moderate/weak CYP450 3A4 inhibitors: Consider reducing the dose of this drug if hypotension occurs.

Other Comments

Administration advice:

-For all oral routes, this drug should be given 1 hour before OR 2 hours after a meal.

-Alkaline mixtures should be avoided before/after administrating oral tablet formulations.

-Oral formulations of this drug should be limited to enteral routes (e.g. oral, nasogastric tube, gastric tube).

-After nasogastric or gastric tube administration, the syringe should be rinsed with 20 to 30 mL of 0.9% saline solution to flush remaining contents from the nasogastric or gastric tube into the stomach.

-Intravenous nimodipine may be administered during anesthesia or surgical procedures.

Storage requirements:

-Capsule formulations: Protect from light and freezing.

-Oral solution formulations: Protect from light; do not refrigerate.

-Oral tablet formulations: Protect from moisture and light.

-Parenteral formulations: Protect from light and freezing.

Reconstitution/preparation techniques:

-For those unable to swallow a capsule, oral administration may be achieved by using a syringe to extract the gel inside the capsule, then administering the gel into the patient’s nasogastric tube or G-tube.

IV compatibility:

-The manufacturer product information should be consulted.

General:

-Grapefruit juice should be avoided during treatment.

-Treatment for traumatic subarachnoid hemorrhage is not recommended as a positive benefit has not been established.

Monitoring:

-Cardiovascular: Blood pressure, heart rate

Patient advice:

-Inform patients that this drug may cause dizziness, and they should avoid driving or operating machinery if these side effects occur.

-Advise patients to speak to their healthcare provider if they become pregnant, intend to become pregnant, or are breastfeeding.

-Patients should be instructed to avoid grapefruit juice during treatment.

What is the dose of Nimodipine for a child?

The dosage has not been established in pediatric patients. It may be unsafe for your child. It is always important to fully understand the safety of the drug before using. Please consult with your doctor or pharmacist for more information.

How is Nimodipine available?

Nimodipine is available in the following dosage forms and strengths:

  • Oral capsule,
  • Oral liquid.

What should I do in case of an emergency or overdose?

In case of an emergency or an overdose, call your local emergency services or go to your nearest emergency room.

What should I do if I miss a dose?

If you miss a dose of Nimodipine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and take your regular dose as scheduled. Do not take a double dose.

Hello Health Group does not provide medical advice, diagnosis or treatment.

Sources

Review Date: April 5, 2018 | Last Modified: April 5, 2018

Want to live your best life?
Get the Hello Doktor Daily newsletter for health tips, wellness updates and more.