NIMODIPINE

COMMON BRAND NAME(S): Nymalize

GENERIC NAME(S): NIMODIPINE

Description: Nimodipine is a calcium channel blocker that relaxes narrowed blood vessels in the brain near the area of bleeding so blood can flow more easily

Pharmacokinetics:

Absorption: Rapidly absorbed from the GI tract. Bioavailability: Approx 13%. Time to peak plasma concentration: 1 hr.

Distribution: Crosses blood-brain barrier but concentrations in CSF are lower than those in plasma. Plasma protein binding: >95%.

Metabolism: Hepatically metabolised via CYP3A4 isoenzyme. Undergoes extensive first-pass metabolism.

Excretion: In faeces via bile, via urine (as metabolites). Terminal half-life: Approx 9 hr.

Uses

Used to
- Decrease problems due to a certain type of bleeding in the brain (subarachnoid hemorrhage-SAH).
Nimodipine is called a calcium channel blocker is thought to work by relaxing narrowed blood vessels in the brain near the area of bleeding so blood can flow more easily thereby reduceing brain damage.

May also be used to decrease problems due to stroke.

How to use nimodipine

Always refer to your doctors instructions before taking this medication. Duration and dosage will be determined by your medical condition and its response to the medication. Make sure to take this mediciation in the prescribed amount and time period even after symptoms disappear. Discontinuing the medication before completion of treatment may cause incomplete treatment of condition. If Symptoms persist, consult your doctor
Taken by mouth and is usually started as soon as possible after the start of bleeding in the brain, usually within 4 days; usually taken every 4 hours or as directed by your doctor.

Tablet form
- take it by mouth with a full glass of water (8 ounces/240 milliliters) unless your doctor directs you otherwise. Do not lie down for 10 minutes after taking this medication. Swallow the tablet whole. Do not crush.
Capsule form
- take it by mouth at least 1 hour before and 2 hours after meals, or as directed by your doctor. Swallow the capsule whole. If you cannot swallow a whole capsule, you may poke a hole in the capsule, draw the liquid out with a syringe, and give it by mouth or through a nasogastric tube with an oral syringe. Do not mix the contents of the capsule with other liquids. Doing so may prevent the medication from working. Do not inject this medication.

Liquid form (oral solution)
- Use a special measuring device/spoon for every dosage and not household spoon to avoid incorrect dose.
- Use the liquid form at least 1 hour before and 2 hours after meals. The liquid form may also be given through a tube into the stomach (nasogastric or gastric tube). If you are giving this medication through a nasogastric or gastric tube, ask your health care professional for detailed instructions on how to give it.

Do not take antacids for 2 hours before or after taking nimodipine tablets. Doing so may prevent the medication from working.

Avoid eating grapefruit or drinking grapefruit juice while using this medication unless your doctor or pharmacist says you may do so safely. Grapefruit can increase the chance of side effects with this medicine. Ask your doctor or pharmacist for more details.

Warnings

Should not be given by injection. Accidental injection of nimodipine can cause serious (rarely fatal) side effects (such as low blood pressure, slow heartbeat). Consult your doctor or pharmacist for details.

Side effects

- Minor side effects (if these symptoms persist or worsen, inform your doctor)
  - Dizziness, lightheadedness, flushing, or swelling ankles/feet
- Serious side effects (inform your doctor immediately)
  - fainting, slow/fast heartbeat, severe abdominal pain, stomach bloating, inability to have a bowel movement for more than 3 days, severe nausea/vomiting, vision changes.
- Severe allergic reactions are rare. Get immediate medical help if you notice the following:
Rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing

Precautions

- Precautions:
  - Inform your doctor
    - Allergy to the medication or to other dihydropyridine calcium channel blockers (such as amlodipine, nifedipine) or any allergies
    - Medical History of chest pain/recent heart attack, low blood pressure, recent head injury, liver disease.
  - May cause dizziness. Limit alcohol intake
  - Older adults may be more sensitive to the side effects of this drug, especially dizziness, or swelling of ankles/feet and can increase the risk of falling.
  - Should only be used when there is a clear need during pregnancy as it may harm an unborn baby. If you are planning to be pregnant or think you may be pregnant, discuss the risks and benefits of use with your doctor.
  - Consult your doctor before breast-feeding as this medication passes into breast milk and may cause unwanted effects on your baby
  Interactions:
  
  Taking multiple drugs may affect how medications work and/or cause unwanted side effects. List down all the medications you are taking and inform your physician and pharmacist. Do not take, discontinue, or alter any dose of medications without prior approval of your physician.
  - Products that may interact with this medication include:
    - drugs for high blood pressure (such as beta blockers including propranolol and metoprolol, ACE inhibitors such as benazepril and enalapril), other calcium channel blockers (such as diltiazem, verapamil), cimetidine, azole antifungals (such as itraconazole), macrolide antibiotics (such as erythromycin), rifamycins (such as rifabutin), St. John’s wort, drugs used to treat seizures (such as carbamazepine, phenytoin), among others.
  Double check all the labels of the medications you are currently taking such as cough-and-cold products, diet aids, nonsteroidal anti-inflammatory drugs-NSAIDs for pain/fever) because they may contain ingredients that could increase your blood pressure or heart rate (such as pseudoephedrine, phenylephrine, ibuprofen, naproxen) that may increase your risk of side effects

Overdose & Brands

- Overdose: If overdose is suspected, contact a poison control center or emergency room immediately.
  
  Missed Dose
  
  If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose and As soon as you remember, take a regular dose or if the time of the next dose is near, wait for it before taking another dose and resume your usual schedule. Do not increase the dose to compensate for the missed dose.
  
  Storage
  - Room temperature 77 degrees F (25 degrees C) in the original foil packets.
  - Brief storage between 59-86 degrees F (15-30 degrees C) is allowed.
  - Do not expose to light and moisture
  - Do not store in the bathroom
  - Keep all medications away from pets and children
  Brands:
  
  Also marketed as:
  
  Nimodin [ Swiss Parenterals ]
- Nimotop [ Bayer ]