Class
- Calcium channel blocker
Nimodipine
Commonly Prescribed for
(FDA approved in bold)
- Prevention of vasospasm in subarachnoid hemorrhage (SAH)
- Hypertension
- Traumatic brain injury
- Reversible cerebral vasoconstrictive syndromes
Nimodipine
How the Drug Works
- Cardiac and vascular smooth muscle contraction depends on movement of calcium through L-type calcium channels into cells, which is inhibited by nimodipine. In animals, nimodipine has a greater effect on cerebral arteries compared with other calcium channel blockers, probably because it is more lipophilic. There is no angiographic evidence that this is correct
Nimodipine
How Long Until It Works
- Within hours for both SAH vasospasm and hypertension
Nimodipine
If It Works
- Prevents delayed ischemic complications after SAH caused by vasospasm, improves recovery time and reduces disability
- Typically used for 3 weeks
Nimodipine
If It Doesn’t Work
- Continue supportive care. Alternative but unproven treatments include statins and magnesium sulfate
Nimodipine
Best Augmenting Combos for Partial Response or Treatment-Resistance
- Treatment of SAH should take place in a medical center with experience and 24-hour physician availability
- Occlude the aneurysm in SAH by surgery or coiling
- Do not treat hypertension aggressively
- Normovolemia is preferred
- Treat hyperglycemia and use measures to avoid deep vein thrombosis
Nimodipine
Tests
- Monitor blood pressure and heart rate
Adverse Effects (AEs)
Nimodipine
How Drug Causes AEs
- Direct effects of L-type calcium receptor antagonism on cardiac and smooth muscle
Nimodipine
Notable AEs
- Hypotension, bradycardia
- Flushing, headache, constipation, nausea, myalgia, edema
Nimodipine
Life-Threatening or Dangerous AEs
- Rare elevation of hepatic transaminases or thrombocytopenia
- May slow AV conduction or worsen symptoms of heart failure
Nimodipine
Weight Gain
- Unusual
Nimodipine
Sedation
- Unusual
