ADMINISTRATION ROUTES:
PO, NG, IV
ALTERNATIVE NAMES:
Nimotop
ICU INDICATIONS:
- Prophylaxis and treatment of cerebral vasospasm after aneursymal subarachnoid haemorrhage
PRESENTATION AND ADMINISTRATION:
PO/NG:
Nimotop tablets 30 mg (yellow)
IV:
Nimotop infusion solution: 10 mg nimodipine / 50 mL
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 - do not dilute. Give via a three-way stopcock with a coinfusion of compatible IV fluid in a ratio of 1:4 (nimodipine: co-infusion). For example, an infusion running at 10 mL/hr requires a co-infusion of 40 mL/hr
Compatible with the following IV fluids: 0.9% saline, 5% dextrose, Hartmann's, Mannitol 10%, 5% albumin
Store at room temperature
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)
DOSAGE:
Enteral dosing is the preferred route of administration. Nimodopine should be administered to every patient with aneurysmal subarachnoid haemorrhage for 21 days after diagnosis, unless otherwise directed.
For patients NOT requiring noradrenaline:
PO/NG:
60 mg every 4 hours
If hypotensive but not requiring noradrenaline, decrease dose to:
30 mg every 4 hours
For patients requiring noradrenaline:
Continue to administer nimodipine. Adjust the dose if required using the following guidance:
PO/NG:
60 mg every 4 hours
If noradrenaline rate exceeds 10 mL/h (of standard 100 mcg/mL ICU concentration), decrease dose to:
30 mg every 2 hours
If MAP target is not achieved despite noradrenaline escalation, decrease dose further to:
30 mg every 4 hours or withhold individual doses
Withhold nimodipine completely if noradrenaline > 15 mL/h. Restart nimodipine towards full dose as soon as possible.
IV:
Start infusion at 1 mg/hr (5 mL/hr) for two hours
Increase to 2 mg/hr (10 mL/ hr) if tolerated
If unable to tolerate, start at 0.5mg/hr (2.5 mL/hr)
Weaning from IV to enteral therapy:
Commence regular oral therapy. 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 shows neurological deterioration likely due to vasospasm, cease wean and return to full IV therapy.
DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:
Dose as in normal renal function
DOSAGE IN PAEDIATRICS:
10 - 15 mcg/kg/hr IV for 2 hours then 10-45 mcg/kg/hr
CLINICAL PHARMACOLOGY:
Nimodipine is a calcium channel blocker which has been shown to improve outcome after subarachnoid haemorrhage
CONTRAINDICATIONS:
- Hypersensitivity to nimodipine
WARNINGS:
Nimodipine can cause hypotension. If this occurs, the dose or frequency should be adjusted, or noradrenaline commenced or increased to support its administration. See the DOSAGE section for guidance on dose adjustment.
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)
Laboratory Tests:
No tests in addition to usual ICU tests are indicated
Drug/Laboratory Test Interactions:
None of note
IMPORTANT DRUG INTERACTIONS IN ICU:
The risk of hypotension increases with concomitant administration of other antihypertensive drugs
ADVERSE REACTIONS:
Cardiovascular:
Hypotension, tachycardia, bradycardia
Respiratory:
Dyspnoea
Gastrointestinal:
Nausea, dyspepsia, deranged liver function tests, diarrhoea
Neurological:
Headache