NIMODIPINE

NIMODIPINE
(ni-mo'di-peen)
Nimotop
Classifications: calcium channel blocker; cerebral antispasmodic agent;
Therapeutic: cerebral antispasmodic
; calcium channel blocker
Prototype: Nifedipine
Pregnancy Category: C

Availability

30 mg capsule

Action

Calcium channel blocking agent that is relatively selective for cerebral arteries compared with arteries elsewhere in the body. This may be attributed to the drug's high lipid solubility and specific binding to cerebral tissue.

Therapeutic Effect

Reduces vascular spasms in cerebral arteries during a stroke.

Uses

To improve neurologic deficits due to spasm following subarachnoid hemorrhage from ruptured congenital intracranial aneurysms in patients who are in good neurological condition posticus (e.g., Hunt and Hess Grades I–III).

Unlabeled Uses

Migraine headaches, ischemic seizures.

Contraindications

Near-fatal reaction to intravenous administration; hypotension; intraarterial administration; cardiogenic shock; pregnancy (category C), lactation.

Cautious Use

Hepatic impairment; acute MI; heart failure, ventricular dysfunction; and lactation. Safety and effectiveness in children are not established.

Route & Dosage

Subarachnoid Hemorrhage
Adult: PO 60 mg q4h for 21 d, start therapy within 96 h of subarachnoid hemorrhage

Hepatic Impairment
Decrease dose to 30 mg q4h.

Administration

Oral
  • Make a hole in both ends of the capsule with an 18-gauge needle and extract the contents into a syringe if patient is unable to swallow. Empty the contents into an enteral (if in use) tube and wash down with 30 mL of NS.
  • Do not administer nimodipine intravenously (IV) or by other parenteral routes. Deaths and serious, life-threatening adverse reactions have occurred when the contents of nimodipine capsules have been injected parenterally.
  • Store below 40° C (104° F); protect from light.

Adverse Effects (≥1%)

CNS: Headache. CV: Hypotension. GI: Hemorrhage, mild, transient increase in liver function tests.

Interactions

Drug: Hypotensive effects increased when combined with other calcium channel blockers. Food: Grapefruit juice (>1 qt/d) may increase plasma concentrations and adverse effects.

Pharmacokinetics

Absorption: Readily from GI tract; approximately 13% reaches systemic circulation (first pass metabolism). Peak: 1 h. Distribution: Crosses blood–brain barrier; possibly crosses placenta; distributed into breast milk. Metabolism: 85% in liver; 15% in kidneys. Elimination: >50% in urine, 32% in feces. Half-Life: 8–9 h.

Nursing Implications

Assessment & Drug Effects

  • Take apical pulse prior to administering drug and hold it if pulse is below 60. Notify the physician.
  • Establish baseline data before treatment is started: BP, pulse, and laboratory evaluations of liver and kidney function.
  • Monitor frequently for adverse drug effects, including hypotension, peripheral edema, tachycardia, or skin rash.
  • Monitor frequently for dizziness or lightheadedness in older adult patients; risk of hypotension is increased.

Patient & Family Education

  • Report gradual weight gain and evidence of edema (e.g., tight rings on fingers, ankle swelling).
  • Keep follow-up appointments for monitoring of progress during therapy.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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