Nimodipine
NIMOTOP
Pronunciation: nye-MOE-di-peen
“Nemo dipping”
Approved for subarachnoid hemorrhage
What it isDihydropyridine calcium channel blocker with cerebral selectivity; aneurysmal subarachnoid hemorrhage.
Why this oneIt improves neurological outcome after subarachnoid hemorrhage, which no other agent does.
What limits it⚑ Never give it intravenously: cardiac arrest and death have occurred. Hypotension can interrupt the required 21-day course.
FDA-approved for
- subarachnoid hemorrhage (1988)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Subarachnoid hemorrhage (improve neurologic outcome) | adult | 60 mg q4h × 21 days | 60 mg q4h |
Renal Undefined
Hepatic Reduce to 30 mg q4h in cirrhosis/severe hepatic impairment with close BP and HR monitoring
60 mg every 4 hours for 21 consecutive days
Instructions
- Oral use only — never IV or parenteral
- Give at least 1 h before or 2 h after meals
- Swallow whole; if unable, extract contents into an oral (non-Luer) syringe and give via NG/PEG tube, then flush with 30 mL normal saline; label syringe 'Not for IV Use'
- Start as soon as possible within 96 h of SAH onset
- Avoid grapefruit juice
Available strengths
- cap 30 mg
- sol 3, 6 mg/mL
Contraindications
- Concomitant use with strong CYP3A4 inhibitors (e.g., clarithromycin, telithromycin, HIV protease inhibitors, ketoconazole, itraconazole, voriconazole, nefazodone) — risk of significant hypotension
Cautions
- Hypotension
- Avoid strong CYP3A4 inducers
- Caution with potential to exacerbate heart failure or AV conduction
Adverse reactions
- Decreased blood pressure
- Headache
- Edema
- Diarrhea
- Rash
- Nausea
Pregnancy Category C; animal teratogenicity; use only if potential benefit justifies risk
Lactation Undefined
Cost
| Strength | #/mo | generic $/unit | CostPlus | |
|---|---|---|---|---|
| 30 mg | cap | per unit | $1.37/ea | offered |
Generic entry2007
⚠ BOXED WARNING
- Do not administer intravenously; death and cardiac arrest have occurred
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityHypotension and edema therapeutically; overdose can cause prolonged vasodilatory or cardiogenic shock.
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