Nimodipine

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Generic Name of Nimodipine - Learn More

Nimodipine

Nimodipine Precaution - What You Need to Know

Before using nimodipine, it is crucial to consult a healthcare provider to ensure the medication is appropriate, especially in the following situations:
- Hypotension (Low Blood Pressure): Nimodipine can cause a drop in blood pressure, particularly when transitioning from a lying or sitting position to standing. It should be used cautiously in patients with low blood pressure or in those who are at risk of developing hypotension.
- Heart Conditions: Individuals with certain heart conditions, including heart failure, should use nimodipine with caution. The drug can affect the heart's rhythm and may exacerbate certain cardiac issues.
- Liver Disease: Nimodipine is metabolized in the liver, so individuals with liver impairment or cirrhosis may need a dose adjustment, as the drug could accumulate in the body and increase the risk of side effects.
- Renal Disease: Though less of an issue than liver disease, nimodipine should be used cautiously in patients with significant kidney dysfunction, as the drug’s elimination could be affected.
- Pregnancy and Breastfeeding: Nimodipine is classified as a Category C drug during pregnancy, meaning it may be harmful to the fetus. It should only be used if the benefits outweigh the risks. The drug is also present in breast milk, so it should be avoided during breastfeeding unless absolutely necessary and prescribed by a healthcare provider.

Nimodipine Indication - Uses and Benefits

Nimodipine is primarily used for conditions related to cerebrovascular health:
- Subarachnoid Hemorrhage (SAH): Nimodipine is most commonly used in the prevention and treatment of cerebral vasospasm following an aneurysmal subarachnoid hemorrhage. After a SAH, nimodipine helps prevent or reduce the risk of vasospasm, which can decrease blood flow to the brain and lead to further neurological damage.
- Cerebral Ischemia: Nimodipine is used to improve outcomes in patients with ischemic brain conditions by promoting blood flow to the brain and preventing the harmful effects of reduced oxygen and nutrients in the brain cells.
- Hypertension (Off-label use): Nimodipine may be used off-label to treat hypertension, particularly in cases where other calcium channel blockers are ineffective or not well-tolerated, though this is not a primary indication.

Nimodipine Contraindications - Important Warnings

Nimodipine should not be used in the following conditions:
- Severe Hypotension: Given its blood pressure-lowering effects, nimodipine should not be used in patients with significant hypotension (low blood pressure) as it could exacerbate symptoms such as dizziness, fainting, or shock.
- Allergy to Nimodipine or Other Calcium Channel Blockers: Individuals with a known hypersensitivity to nimodipine or other calcium channel blockers (e.g., verapamil, diltiazem) should avoid using this medication.
- Severe Liver Impairment: Nimodipine is extensively metabolized in the liver, and its use is contraindicated in patients with severe liver disease or cirrhosis, as it could lead to toxic accumulation in the body.
- Concomitant Use with Strong CYP3A4 Inhibitors: Nimodipine is metabolized by the liver enzyme CYP3A4, and using it concurrently with strong inhibitors of this enzyme (e.g., ketoconazole, ritonavir) can lead to increased levels of the drug, which could cause serious side effects.

Nimodipine Side Effects - What to Expect

Common side effects of nimodipine include:
- Headache: Due to its effects on cerebral blood vessels, nimodipine can cause headaches, particularly when it first starts to take effect.
- Hypotension: As nimodipine works to lower blood pressure, it can cause dizziness, lightheadedness, or fainting, especially when standing up quickly.
- Nausea and Vomiting: Gastrointestinal issues such as nausea or vomiting may occur in some patients taking nimodipine.
- Flushing: Some individuals may experience facial flushing or a sensation of warmth, particularly in the early stages of treatment.
- Edema: Swelling, particularly in the ankles or legs, is another common side effect.
- Bradycardia: Some patients may experience a slow heart rate (bradycardia), which can cause fatigue, dizziness, or fainting.
- Severe Side Effects:
- Severe Hypotension: Excessive blood pressure reduction can lead to dangerously low blood pressure, resulting in symptoms such as fainting, confusion, or shock.
- Liver Dysfunction: Nimodipine may cause elevated liver enzymes, signaling potential liver damage or dysfunction, especially in individuals with pre-existing liver conditions.
- Arrhythmias: Rarely, nimodipine can trigger abnormal heart rhythms, including atrial fibrillation or tachycardia, which could be dangerous for individuals with heart disease.
- Cerebral Ischemia or Bleeding: In rare cases, nimodipine may cause or exacerbate cerebral ischemia or bleeding, especially in individuals with pre-existing brain conditions.

Nimodipine Pregnancy Category ID - Safety Information

3

Nimodipine Mode of Action - How It Works

Nimodipine is a calcium channel blocker that works by inhibiting the influx of calcium ions through L-type calcium channels in the smooth muscle of blood vessels, particularly in the brain:
- Vasodilation: By blocking calcium from entering smooth muscle cells, nimodipine causes the blood vessels to relax and dilate, which reduces vascular resistance and lowers blood pressure.
- Improved Cerebral Blood Flow: In the brain, nimodipine helps improve blood flow, particularly after a subarachnoid hemorrhage (SAH). It prevents cerebral vasospasm (narrowing of the blood vessels), which can result in reduced oxygen and nutrient supply to the brain.
- Reduction of Spasms: Nimodipine has a specific effect on reducing vasospasms, which is especially important after a brain hemorrhage, as it helps prevent secondary damage to the brain tissue.

Nimodipine Drug Interactions - What to Avoid

Nimodipine can interact with several medications, substances, and foods:
- CYP3A4 Inhibitors: Drugs that inhibit the enzyme CYP3A4, such as ketoconazole, itraconazole, clarithromycin, and protease inhibitors, can increase the concentration of nimodipine in the bloodstream, leading to increased side effects, such as hypotension and dizziness.
- CYP3A4 Inducers: Medications like rifampin and carbamazepine that induce CYP3A4 can decrease the blood levels of nimodipine, reducing its effectiveness.
- Other Antihypertensive Drugs: When combined with other antihypertensive medications, such as ACE inhibitors, diuretics, or beta-blockers, nimodipine can cause an additive blood pressure-lowering effect, potentially leading to hypotension.
- Beta-Blockers: Combining nimodipine with beta-blockers (e.g., propranolol, metoprolol) can increase the risk of bradycardia (slowed heart rate) and hypotension, requiring close monitoring of heart rate and blood pressure.
- Grapefruit Juice: Grapefruit juice is known to inhibit the CYP3A4 enzyme, and consuming grapefruit juice while taking nimodipine can increase the blood levels of the drug, leading to an elevated risk of side effects, including hypotension and dizziness.
- Alcohol: Alcohol can enhance the sedative and hypotensive effects of nimodipine, leading to an increased risk of dizziness, drowsiness, and fainting.

Nimodipine Adult Dose - Recommended Dosage

The dosage of nimodipine depends on the clinical condition being treated:
- For Subarachnoid Hemorrhage: The recommended dose is 60 mg every 4 hours, administered orally or via a nasogastric tube, starting within 96 hours of the hemorrhage. Treatment typically lasts for 21 days.
- For Hypertension (Off-label use): The typical dose for hypertension is 30-60 mg of nimodipine taken orally once or twice daily, although this is less commonly used as a primary indication.
- For Cerebral Ischemia (Off-label use): The dose for improving cerebral blood flow and preventing further damage after ischemia is similar to that used for SAH, typically 60 mg every 4 hours.

Nimodipine Child Dose - Dosage for Children

Nimodipine is not commonly used in children, and its use is not well-established in pediatric populations. However, in rare cases of pediatric subarachnoid hemorrhage, a pediatric dose may be recommended:
- For Subarachnoid Hemorrhage in Children: The dosage is typically adjusted based on the child’s age, weight, and clinical condition, with careful monitoring by a pediatrician or neurologist. Dosing may start at 0.25-0.5 mg/kg every 4 hours for children, but this will vary significantly based on the case.

Nimodipine Renal Dose - Dosage for Kidney Conditions

In patients with renal impairment, nimodipine does not require a dose adjustment, as it is not primarily excreted through the kidneys. However, it is still important to monitor renal function, particularly in patients with severe renal insufficiency, to ensure there are no adverse effects.