ADMINISTRATION ROUTES:
PO, NG, IV
ALTERNATIVE NAMES:
Nimotop
ICU INDICATIONS:
- Prophylaxis and treatment of cerebral vasospasm after aneursymal subarachnoid haemorrhage
PRESENTATION AND ADMINISTRATION:
PO/NG:
Nimotop tablets 30 mg (yellow)
IV:
Nimotop infusion solution: 10 mg nimodipine / 50 mL
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 - do not dilute. Give via a three-way stopcock with a coinfusion of compatible IV fluid in a ratio of 1:4 (nimodipine: co-infusion). For example, an infusion running at 10 mL/hr requires a co-infusion of 40 mL/hr
Compatible with the following IV fluids: 0.9% saline, 5% dextrose, Hartmann's, 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)
DOSAGE:
Enteral dosing is the preferred route of administration
PO/NG:
60 mg 4 hourly for 21 days
If not tolerated due to hypotension:
30 mg 4 hourly for 21 days
Do not administer nimodipine if patient is receiving vasoactive infusion(s) to target specific mean arterial or systolic blood pressure targets.
IV:
Start infusion at 1 mg/hr (5 mL/hr) for two hours
Increase to 2 mg/hr (10 mL/ hr) if tolerated
If unable to tolerate infusion at 1 mg/hr, start at 0.5mg/hr (2.5 mL/hr)
Weaning from IV to enteral therapy:
Commence regular oral therapy. 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 shows neurological deterioration likely due to vasospasm, cease wean and return to full IV therapy.
DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:
Dose as in normal renal function
DOSAGE IN PAEDIATRICS:
10 - 15 mcg/kg/hr IV for 2 hours then 10-45 mcg/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 IN 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