Pharm

Nimodipine

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Nimodipine, Nymalize

  • Indications
  1. Cerebral Vasospasm following Subarachnoid Hemorrhage (FDA Approved)
  2. Blood Pressure Control after Cerebrovascular Accident
  • Contraindications
  1. Liver Failure
  2. Hypotension
  • Mechanism
  1. Second Generation Dihydropyridine Calcium Channel Blocker
  2. Inhibits vascular Smooth Muscle contractility
  • Pharmacokinetics
  1. Crosses the blood brain barrier (lipophilic)
  • Safety
  1. Unknown safety in pregnancy
  2. Present in Breast Milk
  • Dosing
  • Adult
  1. Started within 96 hours of event and continued for 21 days
  2. Standard Dose (including in impaired Renal Function)
    1. Nimodipine 60 mg orally or via Nasogastric Tube every 4 hours
  3. Reduced Dose (Cirrhosis)
    1. Nimodipine 30 mg orally or via Nasogastric Tube every 4 hours
  • Precautions
  1. Do NOT use Parenterally due to cardiovascular event risk (may be lethal)
  2. Monitor Blood Pressure
  • Adverse Effects
  1. Hypotension
  2. Headache
  3. Flushing
  4. Palpitations
  5. Nausea
  6. Diarrhea
  • Resources
  1. Nimodipine (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=a323ebd8-ef1b-439b-93d1-ba73a5b0127d
  • References
  1. Spencer and LoVecchio (2021) Crit Dec Emerg Med 35(7): 32
  2. Liu (2011) CNS Neurol Disord Drug Targets 10(7):834-44 +PMID: 21999736 [PubMed]