Classifications: calcium channel blocker; cerebral antispasmodic agent; Therapeutic: cerebral antispasmodic; calcium channel blocker
Pregnancy Category: C
30 mg capsule
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.
Reduces vascular spasms in cerebral arteries during a stroke.
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 IIII).
Migraine headaches, ischemic seizures.
Near-fatal reaction to intravenous administration; hypotension; intraarterial administration; cardiogenic shock; pregnancy
(category C), lactation.
Hepatic impairment; acute MI; heart failure, ventricular dysfunction; and lactation. Safety and effectiveness in children
are not established.
Route & Dosage
Adult: PO 60 mg q4h for 21 d, start therapy within 96 h of subarachnoid hemorrhage
Decrease dose to 30 mg q4h.
- 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.
Hypotensive effects increased when combined with other calcium channel blockers
. Food: Grapefruit juice
(>1 qt/d) may increase plasma
concentrations and adverse effects.
Readily from GI tract; approximately 13% reaches systemic circulation (first pass metabolism
1 h. Distribution:
Crosses bloodbrain barrier; possibly crosses placenta; distributed into breast milk. Metabolism:
85% in liver; 15% in kidneys. Elimination:
>50% in urine, 32% in feces. Half-Life:
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.