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Nimodipine

Classification

Dihydropyridine, calcium channel blocker

Indications

CCP: Subarachnoid hemorrhage

Contraindications

Hypersensitivity
Concomitant use with phenobarbital, phenytoin, carbamazepine, or rifampin
Concomitant use with strong CYP3A4 inhibitors

Adult dosages

CCP: Intracranial hemorrhage

60 mg PO q 4 hours

Pediatric Considerations And Dosing

No data for pediatric use.

Mechanism Of Action

Nimodipine shares the pharmacology of other calcium channel blockers but with a greater affinity on cerebral arterials than other arterials. This increased specificity may be due to the drug's increased lipophilicity and cerebral distribution as compared to nifedipine. Nimodipine inhibits calcium ions from entering the “slow channels” or select voltage sensitive areas of vascular smooth muscle and myocardium during depolarization.

Pharmacokinetics

Time to peak: 0.25-1.05 hours

Half-life: 1-2 hours

Adverse Effects

Cardiovascular

Decreased blood pressure, bradycardia, hypertension, palpitations

Hematological

Anemia, decreased platelet count,
DIC, hematoma, thrombocytopenia

Central nervous system

Headache, dizziness

Dermatological

Diaphoresis, flushing, edema, pruritus

Gastrointestinal

Nausea, vomiting
Gastrointestinal hemorrhage, gastrointestinal pseudo-obstruction, intestinal obstruction

Hepatic

Hepatitis, increased lactate dehydrogenase, increased serum alkaline phosphatase, increased serum ALT, jaundice

Warning And Precautions

Increased angina and/or MI have occurred with initiation or dosage titration of dihydropyridine calcium channel blockers.
Reflex tachycardia may occur resulting in angina and/or MI in patients with obstructive coronary disease.
Use with caution in patients with cirrhosis due to the increased plasma concentrations of nimodipine and an increased risk of adverse reactions.
Use with caution in patients with hypertrophic cardiomyopathy with outflow tract obstruction.
Nimodipine has inadvertently been administered IV when withdrawn from capsules into a syringe for subsequent nasogastric administration. Severe cardiovascular adverse events, including fatalities, have resulted.

Drug Interactions

Abametapir
Alfuzosin
Alpha1-Blockers
Amifostine
Amphetamines
Antipsychotic Agents (Second Generation [Atypical])
Aprepitant
Atosiban
Barbiturates
Benperidol
Brigatinib
Brimonidine (Topical)
Bromperidol
Calcium Salts
Cimetidine
Cladribine
Clofazimine
Clopidogrel
CycloSPORINE (Systemic)
CYP3A4 Inducers (Moderate)
CYP3A4 Inducers (Strong)
CYP3A4 Inducers (Weak)
CYP3A4 Inhibitors (Moderate)
CYP3A4 Inhibitors (Strong)
CYP3A4 Inhibitors (Weak)
Dantrolene
Dapoxetine
Deferasirox
Dexmethylphenidate
Diazoxide
DULoxetine
Erdafitinib
Erdafitinib
Fexinidazole
FLUoxetine
Fosaprepitant
Fusidic Acid (Systemic)
Grapefruit Juice
Herbal Products with Blood Pressure Increasing Effects
Herbal Products with Blood Pressure Lowering Effects
Hypotension-Associated Agents
Ivosidenib
Levodopa-Containing Products
Lormetazepam
Magnesium Sulfate
Melatonin
Methylphenidate
Molsidomine
Naftopidil
Neuromuscular-Blocking Agents (Nondepolarizing
Nicergoline
Nicorandil
Nitroprusside
Obinutuzumab
Pentoxifylline
Pholcodine
Phosphodiesterase 5 Inhibitors
Prostacyclin Analogues
Quinagolide
Sarilumab
Siltuximab
Simeprevir
Sincalide
St John's Wort
Tacrolimus (Systemic
Tocilizumab