Nimocal

Indications

Nimodipine is used to prevent and reduce brain damage caused by narrowing of blood vessels (vasospasm) after a subarachnoid haemorrhage, a type of bleeding around the brain usually from a burst aneurysm.

How It Works

Nimodipine is a calcium channel blocker that acts mainly on the blood vessels of the brain. By blocking calcium entry into the muscle of the vessel walls, it helps keep these vessels relaxed and open, so more blood reaches the brain tissue.

Dosage and Administration

Treatment is started in hospital. The usual adult oral dose is 60 mg every 4 hours, starting within 4 days of the bleed and continued for 21 days, or as prescribed. Swallow tablets whole with water, ideally at least 1 hour before or 2 hours after meals. An injection form is given by a doctor or nurse through a drip. Avoid grapefruit juice.

Interactions

Grapefruit juice, Erythromycin, Clarithromycin, Ketoconazole, some HIV medicines and Cimetidine can raise Nimodipine levels. Rifampicin, Carbamazepine, Phenytoin and Phenobarbital can greatly lower its effect. Other blood pressure medicines can add to its blood pressure lowering effect.

Contraindications

• Allergy to Nimodipine.
• Use with Rifampicin or with the anti-epileptics Carbamazepine, Phenytoin or Phenobarbital.
• Recent heart attack or unstable angina (within 1 month), unless a doctor decides otherwise.

Side Effects

Low blood pressure, flushing, headache, dizziness, fast or slow heartbeat, nausea, stomach upset and swollen ankles may occur. Liver enzymes can rise.

Get urgent medical help for fainting, chest pain, very fast or irregular heartbeat, severe dizziness or signs of an allergic reaction such as swelling of the face or difficulty breathing.

Pregnancy and Lactation

Use in pregnancy only if the doctor judges the benefit outweighs the risk. Nimodipine passes into breast milk, so breastfeeding is usually not advised during treatment.

Precautions and Warnings

Blood pressure is checked closely, especially in people with low blood pressure or brain swelling. Use with care in liver disease, as lower doses may be needed. Oral tablets must never be crushed and given through a vein.

Overdose

Overdose may cause a sharp fall in blood pressure, flushing, headache, fast or slow heartbeat and nausea. This is an emergency; contact a hospital immediately.

Therapeutic Class

Calcium channel blocker (dihydropyridine), cerebral vasodilator.

Storage

Store below 30°C in a dry place, away from light and out of the reach of children. Injection: as directed on the pack.