Nimodipine

Nimodipine

[1 vial $54.00; 1 tablet $3.24]

ADMINISTRATION ROUTES:

  • PO, IV

ALTERNATIVE NAMES:

  • Nimotop

ICU INDICATIONS:

  • Prophylaxis and treatment of cerebral vasospasm after aneursymal subarachnoid haemorrhage

PRESENTATION AND ADMINISTRATION:

  • IV:
  • Nimotop infusion solution: 10mg nimodipine / 50ml
  • Use only infusion pumps with polyethylene (PE) infusion tubing, polypropylene (PP) syringes and polyethylene or polypropylene extensions, taps and connectors.
  • Do not use polyvinylchloride (PVC) infusion tubing as nimodipine is absorbed by the tubing.
  • Administer nimodipine neat.
  • Give via a three-way stopcock with a coinfusion of compatible IV fluid in a ratio of 1:4 (nimodipine: coinfusion).
  • For example, an infusion running at 10ml/hr requires a co-infusion of 40ml/hr.
  • Compatible with the following IV fluids: Normal saline 5% dextrose Hartmanns Mannitol 10% 5% albumin
  • Store at room temperature.
  • Protect from light. Infusion solution is light sensitive. Do not use in direct sunlight.
  • Note: administration of nimodipine via a central line is preferred as nimodipine causes thrombophlebitis when administered peripherally. If necessary, the peripheral route can be used (although administration via this route is not licensed)
  • PO: Nimotop tablets 30mg (yellow)

DOSAGE:

IV:

  • Commence infusion at 1mg/hr (5ml/hr) for two hours and then increase to 2mg/hr (10ml/ hr) if tolerated. For patients who are unable to tolerate infusion at 1mg/hr, commence infusion at 0.5mg/hr (2.5ml/hr)
  • Weaning from IV to oral therapy: Commence regular oral therapy (see below). After the first dose of nimodipine is given, reduce infusion by 1 mL every hour for 5 hours, then cease infusion. If the patient becomes hypotensive after oral nimodipine is given, cease the infusion immediately. Observe for neurological deterioration. If the patient does deteriorate neurologically, cease weaning off IV nimodipine and return to full IV therapy.

PO:

  • 60mg 4 hourly for 21 days; if not tolerated due to hypotension, try a reduced dose of 30mg 4 hourly.

DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:

  • Dose as in normal renal function

DOSAGE IN PAEDIATRICS:

  • 10-15mcg/kg/hr IV for 2 hours then 10-45mcg/kg/hr

CLINICAL PHARMACOLOGY:

  • Nimodipine is a calcium channel blocker which has been shown to improve outcome after subarachnoid haemorrhage

CONTRAINDICATIONS:

  • Hypersensitivity to nimodipine

WARNINGS Nimodipine can cause hypotension. If hypertensive therapy is being pursued or the patient develops significant hypotension during nimodipine treatment, the dose should be reduced or nimodipine should be withheld.

PRECAUTIONS

  • General
    • The metabolism of nimodipine is decreased in patients with impaired hepatic function. Such patients should have their blood pressure and pulse rate monitored closely and should be given a lower dose. (usually 50% of normal dose)
  • Laboratory Tests:
    • No tests in addition to usual ICU tests are indicated
  • Drug/Laboratory Test Interactions:
    • None of note

IMPORTANT DRUG INTERACTIONS FOR THE ICU

  • The risk of hypotension increases with concomitant administration of other antihypertensive drugs.

ADVERSE REACTIONS

  • Cardiovascular:
    • Hypotension, tachycardia, bradycardia
  • Respiratory:
    • Dyspnoea
  • Gastrointestinal:
    • Nausea, dyspepsia, deranged liver function tests, diarrhoea
  • Neurological:
    • Headache

Critical Care Drug Manual

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