Do not administer IV or by other parenteral routes. Deaths and serious, life-threatening adverse events have occurred when the contents of caps have been injected parenterally.
OTHER BRAND NAMES
Calcium channel blocker (CCB)
Improvement of neurological outcome by reducing the incidence and severity of ischemic deficits in patients with subarachnoid hemorrhage (SAH) from ruptured intracranial berry aneurysms regardless of their post-ictus neurological condition (eg, Hunt and Hess Grades I-V).
Indicated for the improvement of neurological outcome by reducing the incidence and severity of ischemic deficits in patients w/ subarachnoid hemorrhage (SAH) from ruptured intracranial berry aneurysms regardless of their post-ictus neurological condition (eg, Hunt and Hess Grades I-V)
Usual: 60mg q4h for 21 days; begin therapy w/in 96 hrs of onset of SAH
Cirrhosis: Reduce to 30mg q4h; consider discontinuation of therapy, if necessary
Swallow caps whole w/ a little liquid, preferably not less than 1 hr before or 2 hrs after meals
If patient cannot swallow cap, extract contents into syringe, empty into NG tube, and wash down the tube w/ 30mL of 0.9% NaCl
Do not administer nimodipine capsules IV or by other parenteral routes
Concomitant use with strong CYP3A4 inhibitors such as some macrolide antibiotics (eg, clarithromycin, telithromycin), some anti-HIV protease inhibitors (eg, indinavir, ritonavir, saquinavir), some azole antimycotics (eg, ketoconazole, itraconazole, voriconazole), and some antidepressants (eg, nefazadone).
Lowering of BP reported; carefully monitor BP. Decreased metabolism in patients with impaired hepatic function; closely monitor BP and pulse rate and give a lower dose. Rare reports of intestinal pseudo-obstruction and ileus. Caution in elderly.
Decreased BP, diarrhea.
See Contraindications. Strong CYP3A4 inducers (eg, rifampin, phenobarbital, phenytoin) may significantly reduce levels and efficacy; avoid concomitant use. Moderate and weak CYP3A4 inhibitors (eg, amiodarone, erythromycin, valproic acid) may increase levels; monitor BP and reduce nimodipine dose if necessary. Not recommended with grapefruit/grapefruit juice. Moderate and weak CYP3A4 inducers (eg, efavirenz, pioglitazone, prednisone) may reduce efficacy; increase in nimodipine dose may be required. May increase the BP lowering effect of antihypertensives; monitor BP and dose adjustment of the BP lowering drug(s) may be necessary.
PREGNANCY AND LACTATION
Category C, not for use in nursing.
MECHANISM OF ACTION
CCB; has not been established. Inhibits Ca2+ ion transfer into smooth muscle cells, thereby inhibiting contractions of vascular smooth muscle.
Absorption: Rapid; Tmax=1 hr; bioavailability (13%). Distribution: Plasma protein binding (>95%). Metabolism: Via CYP3A4. Elimination: Urine (<1% unchanged); T1/2=8-9 hrs.
Assess for hepatic impairment, pregnancy/nursing status, and possible drug interactions.
Monitor for intestinal pseudo-obstruction, ileus and other adverse reactions. Carefully monitor BP and pulse rate.
Inform about potential risks/benefits of therapy.
20-25°C (68-77°F). Protect from light and freezing.
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