Nimodipine

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Nimodipine Brand Names- Nimotop | Nymalize

What is Nimodipine

Nimodipine is an oral calcium-channel blocking agent. Because of its selectivity for cerebral arterioles, it is used to treat subarachnoid hemorrhage (SAH) rather than hypertension, as other dihydropyridines are used.

Nimodipine has shown efficacy for off-label use in the prophylaxis of migraine.

Nimodipine has negligible effects on AV node conduction, similar to other members of the dihydropyridine subgroup.

Nimodipine is FDA-approved only for enteral administration (oral, nasogastric tube or gastric tube) for the treatment of SAH. Nimodipine must not be administered intravenously or by any parenteral route.

If administered intravenously or parenterally, the drug can cause serious adverse events, including cardiovascular collapse and death.

The FDA has received numerous reports of medication administration errors in which nimodipine was given intravenously or parenterally, rather than orally. In addition to a fatal case reported in 2005, there has been a history of these errors.

Two cases were reported in 1995. Another case, which resulted in death, was reported in 1996.

After the 1996 case, the manufacturer, included a bolded statement in the labeling, warning against incorrect administration. Additional non-fatal cases were reported in 1999 and in 2002. A black box warning was added to the nimodipine labeling to describe the life-threatening risk of inadvertent parenteral administration.

In May, 2013 an oral solution was FDA-approved for use in patients who cannot swallow a capsule.

Nimodipine was approved by the FDA in December 1988.

Indications

  • migraine prophylaxis
  • subarachnoid hemorrhage

For the reduction of the incidence and severity of ischemic deficits associated with subarachnoid hemorrhage (SAH) from ruptured berry aneurysms (regardless of post-ictus neurological condition, includes all Hunt and Hess Grades I-V)

Side Effects

  1. anemia
  2. asthenia
  3. bradycardia
  4. cardiac arrest
  5. diaphoresis
  6. diarrhea
  7. dizziness
  8. elevated hepatic enzymes
  9. fatigue
  10. flushing
  11. GI bleeding
  12. headache
  13. heart failure
  14. hematoma
  15. hepatitis
  16. hypertension
  17. hypotension
  18. jaundice
  19. myalgia
  20. nausea
  21. palpitations
  22. peripheral edema
  23. peripheral vasodilation
  24. pruritus
  25. rash
  26. syncope
  27. thrombocytopenia
  28. vomiting
  29. wheezing

Monitoring Parameters

  • platelet count

Contraindications

  • acute myocardial infarction
  • bradycardia
  • breast-feeding
  • cardiogenic shock
  • children
  • geriatric
  • heart failure
  • hepatic disease
  • hypotension
  • intraarterial administration
  • intracorporeal administration
  • intramuscular administration
  • intrathecal administration
  • intravenous administration
  • pregnancy
  • ventricular dysfunction

Interactions

  • Acebutolol
  • Acetaminophen; Butalbital
  • Acetaminophen; Butalbital; Caffeine
  • Acetaminophen; Butalbital; Caffeine; Codeine
  • Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine
  • Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine
  • Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine
  • Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine
  • Acetaminophen; Dextromethorphan; Phenylephrine
  • Acetaminophen; Dextromethorphan; Pseudoephedrine
  • Acetaminophen; Dichloralphenazone; Isometheptene
  • Acetaminophen; Guaifenesin; Phenylephrine
  • Acetaminophen; Pseudoephedrine
  • Acrivastine; Pseudoephedrine
  • Aldesleukin, IL-2
  • Alemtuzumab
  • Alfentanil
  • Alprostadil
  • Amifostine
  • Aminolevulinic Acid
  • Amiodarone
  • Amlodipine; Celecoxib
  • Amobarbital
  • Amoxicillin; Clarithromycin; Lansoprazole
  • Amoxicillin; Clarithromycin; Omeprazole
  • Amphetamine; Dextroamphetamine Salts
  • Amprenavir
  • Amyl Nitrite
  • Apalutamide
  • Apomorphine
  • Apraclonidine
  • Aprepitant, Fosaprepitant
  • Asenapine
  • Aspirin, ASA; Butalbital; Caffeine
  • Aspirin, ASA; Butalbital; Caffeine; Codeine
  • Atazanavir
  • Atazanavir; Cobicistat
  • Atenolol
  • Atenolol; Chlorthalidone
  • Atropine; Hyoscyamine; Phenobarbital; Scopolamine
  • Baclofen
  • Barbiturates
  • Belladonna Alkaloids; Ergotamine; Phenobarbital
  • Bendroflumethiazide; Nadolol
  • Benzonatate
  • Benzphetamine
  • Beta-blockers
  • Betaxolol
  • Bisoprolol
  • Bisoprolol; Hydrochlorothiazide, HCTZ
  • Bortezomib
  • Bosentan
  • Brimonidine; Timolol
  • Brompheniramine; Carbetapentane; Phenylephrine
  • Brompheniramine; Dextromethorphan; Phenylephrine
  • Brompheniramine; Hydrocodone; Pseudoephedrine
  • Brompheniramine; Pseudoephedrine
  • Butabarbital
  • Carbamazepine
  • Carbetapentane; Chlorpheniramine; Phenylephrine
  • Carbetapentane; Diphenhydramine; Phenylephrine
  • Carbetapentane; Guaifenesin; Phenylephrine
  • Carbetapentane; Phenylephrine
  • Carbetapentane; Phenylephrine; Pyrilamine
  • Carbetapentane; Pseudoephedrine
  • Carbidopa; Levodopa
  • Carbidopa; Levodopa; Entacapone
  • Carbinoxamine; Dextromethorphan; Pseudoephedrine
  • Carbinoxamine; Hydrocodone; Phenylephrine
  • Carbinoxamine; Hydrocodone; Pseudoephedrine
  • Carbinoxamine; Phenylephrine
  • Carbinoxamine; Pseudoephedrine
  • Carteolol
  • Carvedilol
  • Celecoxib
  • Cenobamate
  • Ceritinib
  • Cetirizine; Pseudoephedrine
  • Chlophedianol; Dexchlorpheniramine; Pseudoephedrine
  • Chlophedianol; Guaifenesin; Phenylephrine
  • Chloroprocaine
  • Chlorpheniramine; Dextromethorphan; Phenylephrine
  • Chlorpheniramine; Dihydrocodeine; Phenylephrine
  • Chlorpheniramine; Dihydrocodeine; Pseudoephedrine
  • Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine
  • Chlorpheniramine; Hydrocodone; Phenylephrine
  • Chlorpheniramine; Hydrocodone; Pseudoephedrine
  • Chlorpheniramine; Phenylephrine
  • Chlorpheniramine; Pseudoephedrine
  • Cimetidine
  • Clarithromycin
  • Co-Enzyme Q10, Ubiquinone
  • Cobicistat
  • Cocaine
  • Codeine; Phenylephrine; Promethazine
  • Conivaptan
  • Crizotinib
  • Dalfopristin; Quinupristin
  • Danazol
  • Dantrolene
  • Darunavir
  • Darunavir; Cobicistat
  • Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide
  • Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir
  • Delavirdine
  • Desloratadine; Pseudoephedrine
  • Dexchlorpheniramine; Dextromethorphan; Pseudoephedrine
  • Dexmedetomidine
  • Dexmethylphenidate
  • Dextromethorphan; Diphenhydramine; Phenylephrine
  • Dextromethorphan; Guaifenesin; Phenylephrine
  • Dextromethorphan; Guaifenesin; Pseudoephedrine
  • Diazoxide
  • Diclofenac
  • Diclofenac; Misoprostol
  • Diethylpropion
  • Diflunisal
  • Dihydrocodeine; Guaifenesin; Pseudoephedrine
  • Diphenhydramine; Hydrocodone; Phenylephrine
  • Diphenhydramine; Ibuprofen
  • Diphenhydramine; Naproxen
  • Diphenhydramine; Phenylephrine
  • Dorzolamide; Timolol
  • Dronedarone
  • Drospirenone; Ethinyl Estradiol
  • Drospirenone; Ethinyl Estradiol; Levomefolate
  • Duloxetine
  • Dutasteride; Tamsulosin
  • Duvelisib
  • Echinacea
  • Efavirenz
  • Efavirenz; Emtricitabine; Tenofovir
  • Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate
  • Elbasvir; Grazoprevir
  • Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide
  • Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate
  • Empagliflozin
  • Empagliflozin; Linagliptin
  • Empagliflozin; Linagliptin; Metformin
  • Empagliflozin; Metformin
  • Enflurane
  • Enzalutamide
  • Ephedrine
  • Epirubicin
  • Eplerenone
  • Epoprostenol
  • Ergonovine
  • Erythromycin
  • Erythromycin; Sulfisoxazole
  • Esmolol
  • Esomeprazole; Naproxen
  • Estradiol
  • Estradiol Cypionate; Medroxyprogesterone
  • Ethinyl Estradiol
  • Ethinyl Estradiol; Desogestrel
  • Ethinyl Estradiol; Ethynodiol Diacetate
  • Ethinyl Estradiol; Etonogestrel
  • Ethinyl Estradiol; Levonorgestrel
  • Ethinyl Estradiol; Levonorgestrel; Ferrous bisglycinate
  • Ethinyl Estradiol; Levonorgestrel; Folic Acid; Levomefolate
  • Ethinyl Estradiol; Norelgestromin
  • Ethinyl Estradiol; Norethindrone
  • Ethinyl Estradiol; Norethindrone Acetate
  • Ethinyl Estradiol; Norethindrone Acetate; Ferrous fumarate
  • Ethinyl Estradiol; Norethindrone; Ferrous fumarate
  • Ethinyl Estradiol; Norgestimate
  • Ethinyl Estradiol; Norgestrel
  • Etodolac
  • Etomidate
  • Everolimus
  • Famotidine; Ibuprofen
  • Fedratinib
  • Fenoprofen
  • Fentanyl
  • Fexofenadine; Pseudoephedrine
  • Fish Oil, Omega-3 Fatty Acids (Dietary Supplements)
  • Fluconazole
  • Fluoxetine
  • Fluoxetine; Olanzapine
  • Flurbiprofen
  • Fosamprenavir
  • Fospropofol
  • Fostamatinib
  • General anesthetics
  • Ginkgo, Ginkgo biloba
  • Ginseng, Panax ginseng
  • grapefruit juice
  • Guaifenesin; Hydrocodone; Pseudoephedrine
  • Guaifenesin; Phenylephrine
  • Guaifenesin; Pseudoephedrine
  • Halothane
  • Hydantoins
  • Hydralazine; Isosorbide Dinitrate, ISDN
  • Hydrochlorothiazide, HCTZ; Metoprolol
  • Hydrochlorothiazide, HCTZ; Propranolol
  • Hydrocodone; Ibuprofen
  • Hydrocodone; Phenylephrine
  • Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine
  • Hydrocodone; Pseudoephedrine
  • Ibuprofen
  • Ibuprofen; Oxycodone
  • Ibuprofen; Pseudoephedrine
  • Idelalisib
  • Iloperidone
  • Iloprost
  • Imatinib
  • Indinavir
  • Indomethacin
  • Intravenous Lipid Emulsions
  • Isavuconazonium
  • Isocarboxazid
  • Isoflurane
  • Isoniazid, INH; Pyrazinamide, PZA; Rifampin
  • Isoniazid, INH; Rifampin
  • Isoproterenol
  • Isosorbide Dinitrate, ISDN
  • Isosorbide Mononitrate
  • Istradefylline
  • Itraconazole
  • Ketamine
  • Ketoconazole
  • Ketoprofen
  • Ketorolac
  • Labetalol
  • Lacosamide
  • Lanreotide
  • Lansoprazole; Naproxen
  • Lapatinib
  • Larotrectinib
  • Lasmiditan
  • Lefamulin
  • Lesinurad
  • Lesinurad; Allopurinol
  • Letermovir
  • Levobetaxolol
  • Levobunolol
  • Levodopa
  • Lisdexamfetamine
  • Lithium
  • Lopinavir; Ritonavir
  • Loratadine; Pseudoephedrine
  • Lorlatinib
  • Lovastatin; Niacin
  • Lumacaftor; Ivacaftor
  • Meclofenamate Sodium
  • Mefenamic Acid
  • Melatonin
  • Meloxicam
  • Mephobarbital
  • Mestranol; Norethindrone
  • Methamphetamine
  • Methohexital
  • Methoxsalen
  • Methylphenidate
  • Methysergide
  • Metoprolol
  • Mifepristone
  • Milrinone
  • Mitotane
  • Nabumetone
  • Nadolol
  • Naproxen
  • Naproxen; Pseudoephedrine
  • Naproxen; Sumatriptan
  • Nebivolol
  • Nebivolol; Valsartan
  • Nefazodone
  • Nelfinavir
  • Nesiritide, BNP
  • Neuromuscular blockers
  • Nevirapine
  • Niacin, Niacinamide
  • Niacin; Simvastatin
  • Nitrates
  • Nitroglycerin
  • Nitroprusside
  • Nonsteroidal antiinflammatory drugs
  • Octreotide
  • Olanzapine
  • Ombitasvir; Paritaprevir; Ritonavir
  • Omeprazole; Amoxicillin; Rifabutin
  • Oritavancin
  • Osilodrostat
  • Oxaprozin
  • Oxymetazoline
  • Palbociclib
  • Paliperidone
  • Pasireotide
  • Pazopanib
  • Penbutolol
  • Pentobarbital
  • Pentoxifylline
  • Phenelzine
  • Phenobarbital
  • Phenylephrine
  • Phenylephrine; Promethazine
  • Photosensitizing agents (topical)
  • Pindolol
  • Piroxicam
  • Posaconazole
  • Prazosin
  • Primidone
  • Procainamide
  • Procaine
  • Propofol
  • Propranolol
  • Protease inhibitors
  • Pseudoephedrine
  • Rasagiline
  • Remifentanil
  • Ribociclib
  • Ribociclib; Letrozole
  • Rifabutin
  • Rifampin
  • Rifapentine
  • Risperidone
  • Ritonavir
  • Rofecoxib
  • Rucaparib
  • Saquinavir
  • Secobarbital
  • Segesterone Acetate; Ethinyl Estradiol
  • Selegiline
  • Selpercatinib
  • Sevoflurane
  • Silodosin
  • Simeprevir
  • Sincalide
  • Sotalol
  • St. John’s Wort, Hypericum perforatum
  • Streptogramins
  • Sufentanil
  • Sulindac
  • Tamsulosin
  • Tazemetostat
  • Telithromycin
  • Telotristat Ethyl
  • Temsirolimus
  • Tetrabenazine
  • Tetracaine
  • Thalidomide
  • Thiopental
  • Thiothixene
  • Timolol
  • Tipranavir
  • Tolmetin
  • Tranylcypromine
  • Trazodone
  • Treprostinil
  • Tucatinib
  • Valdecoxib
  • Valproic Acid, Divalproex Sodium
  • Vemurafenib
  • Verteporfin
  • Voriconazole
  • Yohimbine
  • Zafirlukast
  • Ziprasidone

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