Nimodipine

NIMODIPINE

Manufacturer: BIONPHARMA INC.

Score: 144.0

Quick Summary

Nimodipine is a calcium channel blocker used to improve neurological outcomes in patients with subarachnoid hemorrhage. It works by inhibiting calcium ion transfer into vascular smooth muscle cells, thus reducing the severity of neurological deficits caused by cerebral vasospasm. Clinical trials have demonstrated its effectiveness in reducing the incidence and severity of ischemic deficits. However, it has important safety considerations, including the risk of significant hypotension, and contraindications with strong inhibitors of CYP3A4. The recommended oral dose is 60 mg every 4 hours for 21 consecutive days, with special considerations for patients with liver cirrhosis, elderly patients, and those taking certain medications. Nimodipine should be used with caution in pregnant women, nursing mothers, and pediatric patients due to limited data and potential risks.

Key Clinical Findings and Indications

Improves neurological outcomes in patients with subarachnoid hemorrhage
Reduces the incidence and severity of ischemic deficits
Effective in patients with Hunt and Hess Grades I-V
Reduces the overall rate of infarction and severely disabling neurological outcome

Important Safety Information

Warning

Do not administer intravenously or by other parenteral routes due to risk of significant hypotension and life-threatening adverse events

Contraindications

Strong inhibitors of CYP3A4 (e.g., clarithromycin, ketoconazole)
Concomitant use with certain anti-HIV protease inhibitors, azole antimycotics, and antidepressants

Adverse Reactions

Decreased blood pressure
Edema
Headache
Abnormal liver function tests
Diarrhea
Rash

Dosing Recommendations

General Guidance

Reduce dose to 30 mg every 4 hours in patients with liver cirrhosis; monitor blood pressure and adjust dose as needed

Subarachnoid hemorrhage

Adult Dose

60 mg every 4 hours for 21 consecutive days

Pediatric Dose

Not established

Special Population Considerations

Pregnancy

Pregnancy Category C
Use only if potential benefit justifies potential risk to fetus
Nimodipine has been shown to have teratogenic effects in animal studies

Nursing Mothers

Nimodipine and/or its metabolites appear in rat milk at high concentrations
Nursing mothers are advised not to breastfeed their babies when taking the drug

Pediatric Use

Safety and effectiveness have not been established in children
Use with caution in pediatric patients due to limited data

Geriatric Use

Clinical studies did not include sufficient numbers of subjects aged 65 and over
Dosing in elderly patients should be cautious, reflecting greater frequency of decreased hepatic, renal, or cardiac function