nimodipine: clinical use

Prescribing considerations

• Confirm aneurysmal rather than traumatic subarachnoid haemorrhage and whether tablets or infusion are intended.
• Use particular caution with hypotension, cerebral oedema, severely raised intracranial pressure or cirrhosis.
• Safety and efficacy have not been established in patients under 18 years.
• Review CYP3A4 inhibitors, inducers and concurrent antihypertensive therapy.

Contraindications and cautions

• Hypersensitivity to nimodipine or formulation excipients
• Current or recent myocardial infarction, or unstable angina
• Oral nimodipine with rifampicin, phenobarbital, phenytoin or carbamazepine
• Concurrent nimodipine tablets and nimodipine infusion

Monitoring

• Blood pressure and pulse
• Neurological status
• Renal function during intravenous treatment when renal disease or nephrotoxic medicines are present
• Infusion site for inflammation or thrombophlebitis

Clinical pharmacology

Nimodipine is a highly protein-bound dihydropyridine calcium-channel blocker with preferential cerebrovascular effects. It undergoes extensive first-pass metabolism, predominantly through CYP3A4.

Formulation and product differences

• Tablets are for oral use.
• The infusion contains ethanol and sodium citrate, is light-sensitive and requires compatible glass, polyethylene or polypropylene equipment.
• The oral and intravenous formulations must not be administered concurrently.

Solution for infusion

Route: Intravenous

Strengths: 0.02%

Tablet

Route: Oral

Strengths: 30 mg