Nimodipine parenteral
- Drugs List
- Therapeutic Indications
- Dosage
- Administration
- Contraindications
- Precautions and Warnings
- Pregnancy and Lactation
- Side Effects
- Monograph
Presentation
Solution for infusion of nimodipine.
Drugs List
Therapeutic Indications
Uses
Treatment of neurological deficit after aneurysmal subarachnoid haemorrhage
Dosage
Nimodipine solution may be used during anaesthesia, angiography or surgical procedures.
Adults
1 mg/hour by intravenous infusion for the first two hours (approximately 15 micrograms/kg/hour) followed by 2 mg/hour (approximately 30 micrograms/kg/hour) providing no severe decrease in blood pressure is observed.
Patients weighing less than 70kg or with unstable blood pressure should be started on 500 micrograms/hour or less if necessary.
Intravenous nimodipine therapy should be initiated as soon as possible after the neurological deficit occurs and should continue for at least five days (maximum of fourteen days).
In the event of surgical intervention during treatment, administration of nimodipine should continue for at least five days, following the above dosage regime.
Children
Treatment of vasospasm following subarachnoid haemorrhage (unlicensed)
Children aged 12 to 18 years
Initially, 500 micrograms/hour (up to 1 mg/hour if bodyweight over 70kg and blood pressure stable). Increase after 2 hours to 1 to 2 mg/hour if no severe fall in blood pressure.
Continue for at least five days (for a maximum of fourteen days).
Children aged 1 month to 12 years
Initially, 15 micrograms/kg/hour (up to a maximum of 500 micrograms/hour) or 7.5 micrograms/kg/hour if blood pressure unstable. Increase after 2 hours to 30 micrograms/kg/hour (up to a maximum of 2 mg/hour) if no severe decrease in blood pressure.
Continue for at least five days (for a maximum of fourteen days).
Additional Dosage Information
In the event of nimodipine tablets and nimodipine solution being administered sequentially, the total duration of treatment should not exceed twenty one days.
Nimodipine solution should not be administered for longer than fourteen days.
Nimodipine solution and tablets should not be used concurrently.
Administration
For intravenous administration using a central line catheter
Nimodipine solution must be administered with a co-infusion using a three way stopcock. Co-infusion flow rate 40 ml/hour.
Contraindications
Neonates under 1 month
Acute angina
Acute porphyria
Myocardial infarction
Within 1 month of a myocardial infarction
Within 1 month of an unstable angina episode
Precautions and Warnings
Children 1 month to 18 years
Systolic blood pressure below 100mmHg
Alcoholism
Breastfeeding
Cerebral oedema
Epileptic disorder
Hepatic cirrhosis
Hepatic impairment
Pregnancy
Raised intracranial pressure
Renal impairment
Do not administer to patients with traumatic subarachnoid haemorrhage
Sodium content of formulation may be significant
Advise ability to drive/operate machinery may be affected by side effects
Contains alcohol
Do not mix with other drugs or substances
Incompatible with PVC
Monitor blood pressure and heart rate in patients with hepatic impairment
Grapefruit prod increase dihydropyridine Ca channel blocker bioavailability
Nimodipine infusion solution contains 23.7% ethanol. This may be harmful for those suffering alcoholism or impaired alcohol metabolism, and should be taken into account in high risk groups such as liver disease and epilepsy.
Pregnancy and Lactation
Pregnancy
Use nimodipine with caution in pregnancy
There is very limited information on the use of nimodipine during pregnancy.
Schaefer (2007) suggests that calcium channel blocker exposure during the first trimester of pregnancy is an indication for a detailed ultrasound scan but, in general, calcium channel blocker exposure is not an indication for invasive diagnostic procedure or termination.
Nimodipine is teratogenic and toxic in experimental animals.
The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).
Lactation
Use nimodipine with caution in breastfeeding.
The manufacturer states nimodipine and its metabolites have been shown to be present in human milk at concentrations of the same order of magnitude as corresponding maternal plasma concentrations. Nursing mothers are advised not to breastfeed when taking this drug.
Lactmed states the amount ingested by the infant are small and would not be expected to cause any adverse effects in breastfed infants.
Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1
Side Effects
Allergic reaction
Bradycardia
Dizziness
Elevation of liver enzymes (transient)
Gastro-intestinal symptoms
Headache
Hypotension
Ileus
Injection site reactions
Nausea
Phlebitis (injection site)
Rash
Sensation of warmth
Sweating
Tachycardia
Thrombocytopenia
Variation in heart rate
Vasodilation
Overdosage
It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.
The following number will direct the caller to the relevant local centre (0844) 892 0111
Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).
Further Information
Last Full Review Date: December 2013
Reference Sources
Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 2nd edition (2007) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.
Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 9th edition (2011) ed. Briggs, G., Freeman, R. and Yaffe, S. Lippincott Williams & Wilkins, Philadelphia.
Martindale: The Complete Drug Reference, 37th edition (2011) ed. Sweetman, S. Pharmaceutical Press, London.
Medications and Mothers' Milk, 14th Edition (2010) Hale, T. Hale Publishing, Amarillo, Texas.
The Renal Drug Handbook. 3rd edition. (2009) ed. Ashley, C and Currie, Radcliffe Publishing Ltd, Abingdon.
Summary of Product Characteristics: Nimotop 0.02% solution for infusion. Bayer plc. Revised October 2012.
NICE Evidence Services Available at: www.nice.org.uk Last accessed: 23 August 2017
The Drug Database for Acute Porphyria (NAPOS)
Available at: https://www.drugs-porphyria.org/languages/UnitedKingdom/selsearch.php?l=gbr
Nimodipine Last revised: October 1, 2004
Last accessed: December 10, 2013
US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed).
Available at: https://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT
Nimodipine Last revised: September 7, 2013
Last accessed: December 10, 2013
Medscape UK | Univadis prescription drug monographs & interactions are based on FDB Multilex Content
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