NIMODIPINE 🎯

 

ADMINISTRATION  ROUTES: 

PO,  IV

 ICU  INDICATIONS:

 1. Prophylaxis  and  treatment  of  cerebral  vasospasm  after  aneursymal  subarachnoid haemorrhage

 PRESENTATION AND ADMINISTRATION: IV: Nimotop  infusion  solution:  10mg  nimodipine  /  50ml 

Use  only  infusion  pumps  with  polyethylene  (PE)  infusion  tubing,  polypropylene  (PP) syringes  and  polyethylene  or  polypropylene  extensions,  taps  and  connectors.    Do  not use  polyvinylchloride  (PVC)  infusion  tubing  as  nimodipine  is  absorbed  by  the  tubing. Administer  nimodipine  neat.    Give  via  a  three-way  stopcock  with  a  coinfusion  of compatible  IV  fluid  in  a  ratio  of  1:4  (nimodipine:  coinfusion).    For  example,  an  infusion running  at  10ml/hr  requires  a  co-infusion  of  40ml/hr. Compatible  with  the  following  IV  fluids: 

Normal  saline   

5% dextrose    

Mannitol  10%   

5% albumin 

Hartmanns     

Protect  from  light.    Infusion  solution  is  light  sensitive.    Do  not  use  in  direct  sunlight. Note:  administration  of  nimodipine  via  a  central  line  is  preferred  as  nimodipine  causes thrombophlebitis  when  administered  peripherally.    If  necessary,  the  peripheral  route  can be  used  (although  administration  via  this  route  is  not  licensed)

 PO: Nimotop  tablets  30mg  (yellow) 

DOSAGE: IV: Commence  infusion  at  1mg/hr  (5ml/hr)  for  two  hours  and  then  increase  to  2mg/hr  (10ml/ hr)  if  tolerated.    For  patients  who  are  unable  to  tolerate  infusion  at  1mg/hr,  commence infusion  at  0.5mg/hr  (2.5ml/hr) 

Weaning  from  IV  to  oral  therapy: Commence  regular  oral  therapy  (see  below).    After  the  first  dose  of  nimodipine  is  given, reduce  infusion  by  1  mL  every  hour  for  5  hours,  then  cease  infusion.    If  the  patient becomes  hypotensive  after  oral  nimodipine  is  given,  cease  the  infusion  immediately. Observe  for  neurological  deterioration.    If  the  patient  does  deteriorate  neurologically, cease  weaning  off  IV  nimodipine  and  return  to  full  IV  therapy. 

PO: 60mg  4  hourly  for  21  days;  if  not  tolerated  due  to  hypotension,  try  a  reduced  dose  of 30mg  4  hourly. 

 DOSAGE  IN  RENAL FAILURE AND  RENAL REPLACEMENT THERAPY:    Dose  as  in  normal  renal  function   

DOSAGE  IN  PAEDIATRICS: 10-15mcg/kg/hr  IV  for  2  hours  then  10-45mcg/kg/hr

CLINICAL  PHARMACOLOGY: Nimodipine  is  a  calcium  channel  blocker 

 CONTRAINDICATIONS: 1. Hypersensitivity  to  nimodipine Nimodipine WARNINGS Nimodipine  can  cause  hypotension.    If  hypertensive  therapy  is  being  pursued  or  the patient  develops  significant  hypotension  during  nimodipine  treatment,  the  dose  should be  reduced  or  nimodipine  should  be  withheld. 

PRECAUTIONS General The  metabolism  of  nimodipine  is  decreased  in  patients  with  impaired  hepatic  function. Such  patients  should  have  their  blood  pressure  and  pulse  rate  monitored  closely  and should  be  given  a  lower  dose.    (usually  50%  of  normal  dose) 

IMPORTANT  DRUG  INTERACTIONS  FOR THE  ICU: The  risk  of  hypotension  increases  with  concomitant  administration  of  other antihypertensive  drugs.

ADVERSE  REACTIONS 

Hypotension,  tachycardia,  bradycardia, deranged  liver  function  tests,  diarrhoea, Headache