Nimotop

Nimotop (Nimodipine) is used to improve symptoms caused by spasms as a result of a brain hemorrhage (ruptured blood vessels).

Product dosage: 30mg
Package (num)	Per cap	Price	Buy
30	$1.33	$40.00 (0%)	🛒 Add to cart
60	$1.12	$80.00 $67.00 (16%)	🛒 Add to cart
90	$1.04	$120.00 $94.00 (22%)	🛒 Add to cart
120	$1.01	$160.00 $121.00 (24%)	🛒 Add to cart
180	$0.97	$240.00 $175.00 (27%)	🛒 Add to cart
270	$0.95	$360.00 $256.00 (29%)	🛒 Add to cart
360	$0.94 Best per cap	$480.00 $338.00 (30%)	🛒 Add to cart
Synonyms Acival Ac vascular Admon Aniduv Antis Befimat Bloquel Brainal Brainox Calnit Cebrofort Ceremax Curban Dilceren Eugerial Explaner Figozant Finacilen Genovox Grifonimod Irricer Irrigandum Irrigor Irrisana Iskidrop Kenesil Macobal Megavital Modip Modipin Myodipine Naborel Nemodine Nemotan Neurocal Neurogeron Nidip Nimobal Nimobrain Nimocal Nimodil Nimodilat Nimodip Nimodipin Nimodipina Nimodipino Nimodipinum Nimopidina Nimopin Nimovac-v Nisom Nivas Noodipina Nortolan Oxigen Periplum Regental Remontal Rosital Sobrepina Stigmicarpin Tenocard Thrionipen Trinalion Tropocer Vacer Vasoactin Vasotop Vastripine Ziremex

Nimotop (nimodipine) is a calcium channel blocker specifically formulated for the improvement of neurological outcomes by reducing the incidence and severity of ischemic deficits in patients with subarachnoid hemorrhage (SAH) from ruptured congenital intracranial aneurysms. Its unique cerebroselective action targets cerebral arteries, making it a cornerstone of post-hemorrhagic neurological care. This product card provides a comprehensive, expert-level overview of its pharmacological profile, clinical application, and essential safety information for healthcare professionals.

Features

• Active Pharmaceutical Ingredient: Nimodipine (30 mg per soft gelatin capsule)
• Pharmacological Class: Dihydropyridine Calcium Channel Blocker
• Formulation: Oral soft gelatin capsules for optimized bioavailability
• Mechanism: Selective inhibition of calcium ion influx into vascular smooth muscle cells, with a preferential effect on cerebral arteries
• Specialized Delivery: Designed for consistent and predictable absorption

Benefits

• Reduces the incidence of cerebral infarction secondary to vasospasm following aneurysmal subarachnoid hemorrhage.
• Improves overall neurological outcome by mitigating delayed ischemic neurological deficits.
• Demonstrates cerebroselective vasodilation, preferentially increasing cerebral blood flow without significant systemic hypotensive effects at recommended doses.
• Provides a well-established safety and efficacy profile backed by extensive clinical research and decades of use in neurosurgical and neurological critical care.
• Oral formulation allows for continued therapy in both inpatient and outpatient settings following the acute phase.

Common use

Nimotop is exclusively indicated for the improvement of neurological outcome by reducing the incidence and severity of ischemic deficits in patients with subarachnoid hemorrhage from ruptured congenital intracranial aneurysms who are in good neurological condition post-ictus (e.g., Hunt and Hess Grades I-III). Its use is initiated within 96 hours of the hemorrhage and is a standard component of post-SAH management protocols to prevent vasospasm, a common and serious complication that can lead to stroke and death.

Dosage and direction

The recommended dosage is 60 mg (two 30 mg capsules) every 4 hours for 21 consecutive days.

• Administration: Oral administration. The capsules should be swallowed whole with a glass of water.
• Timing: Doses should be administered at approximately the same times each day to maintain consistent plasma levels.
• Timing with Meals: To minimize potential gastrointestinal upset, administration one hour before or two hours after meals is often recommended, though this should be balanced with patient tolerance and compliance.
• Nasogastric Tube Administration: For patients who cannot swallow, the liquid contents of the capsule may be extracted via syringe and administered through a nasogastric tube. The tube must then be flushed with 30 mL of normal saline to ensure complete delivery.
• Duration: Treatment should be continued for the full 21-day course unless terminated earlier due to significant adverse effects.

Precautions

• Blood Pressure Monitoring: Blood pressure should be monitored regularly, especially in patients with pre-existing hypertension or those taking other antihypertensive agents, as nimodipine can cause hypotension.
• Liver Impairment: Patients with severe liver dysfunction (e.g., cirrhosis) may have significantly reduced clearance of nimodipine, increasing the risk of adverse effects. Dose reduction may be necessary, and these patients require close monitoring.
• Grapefruit Juice: Concomitant administration with grapefruit juice should be avoided, as it inhibits cytochrome P450 3A4 metabolism, potentially leading to increased plasma levels of nimodipine and an elevated risk of adverse effects.
• GI Motility Disorders: The absorption of nimodipine may be altered in patients with gastrointestinal hypomotility or ileus, which can occur post-SAH or surgery.
• General Anesthesia: Caution is advised with concomitant use of anesthetics known to be potent peripheral vasodilators, as the effects may be additive.

Contraindications

• Known hypersensitivity to nimodipine, any other calcium channel blocker, or any component of the capsule formulation.
• Concomitant use with strong inhibitors of CYP3A4 (e.g., ketoconazole, itraconazole, clarithromycin, ritonavir, nefazodone) due to the high risk of significantly increased nimodipine plasma concentrations and severe hypotension.
• Patients with a history of significantly depressed cardiac function or cardiogenic shock.

Possible side effect

The most common side effect is dose-dependent hypotension. Other possible adverse reactions include:

• Cardiovascular: Bradycardia, tachycardia, palpitations, flushing, peripheral edema.
• Gastrointestinal: Nausea, diarrhea, abdominal discomfort.
• Dermatological: Rash, pruritus.
• Central Nervous System: Headache, depression.
• Hematological: Rare cases of thrombocytopenia have been reported.
• Other: Dyspnea, muscle pain/cramps.

Drug interaction

Nimotop is primarily metabolized by the cytochrome P450 3A4 (CYP3A4) system. Significant interactions include:

• Strong CYP3A4 Inhibitors (Absolute Contraindication): Azole antifungals (e.g., ketoconazole), macrolide antibiotics (e.g., clarithromycin), HIV protease inhibitors (e.g., ritonavir), and nefazodone. Concomitant use can lead to a profound increase in nimodipine plasma levels.
• Other Antihypertensives: Beta-blockers, ACE inhibitors, other calcium channel blockers, diuretics. Additive hypotensive effects are likely; close blood pressure monitoring is essential.
• CYP3A4 Inducers: Drugs such as rifampin, carbamazepine, phenytoin, and St. John’s Wort may decrease the plasma concentration and efficacy of nimodipine.
• Dantrolene: Concomitant use may lead to hyperkalemia and myocardial depression in susceptible animals; the clinical significance in humans is unknown but warrants caution.

Missed dose

If a dose is missed, it should be taken as soon as it is remembered. However, if it is almost time for the next scheduled dose, the missed dose should be skipped. The patient should not double the dose to make up for the missed one. Maintaining the regular dosing schedule is more important than catching up on a single missed dose. Healthcare providers should be informed of the missed dose.

Overdose

• Symptoms: Overdose is expected to be manifested primarily by systemic vasodilation with marked hypotension, possibly accompanied by reflex tachycardia, bradycardia (due to AV block), and gastrointestinal symptoms. Severe hypotension can lead to syncope, falls, and secondary injuries.
• Management: There is no specific antidote. Management consists of cardiovascular support, including:
  • Careful monitoring of cardiac and respiratory function.
  • Elevation of extremities.
  • Judicious administration of vasoconstrictors (e.g., dopamine or norepinephrine) to restore vascular tone and blood pressure.
  • Since nimodipine is highly protein-bound, dialysis is not likely to be of benefit.

Storage

• Store at room temperature between 20°C to 25°C (68°F to 77°F). Excursions are permitted between 15°C and 30°C (59°F and 86°F).
• Protect from light and excessive moisture.
• Keep the bottle tightly closed.
• Keep out of reach of children and pets.

Disclaimer

This information is intended for educational and informational purposes for healthcare professionals only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of a qualified physician or other authorized health provider with any questions you may have regarding a medical condition or before making any changes to a treatment plan. Never disregard professional medical advice or delay in seeking it because of something you have read here. The prescribing physician remains solely responsible for determining the appropriate dosage and treatment regimen for each individual patient, considering their unique medical history and current condition.

Reviews

• “A foundational drug in our neuro-ICU. The evidence for its efficacy in reducing poor outcomes from vasospasm is robust. Managing the hypotension it can cause is a standard part of our protocol.” – Neurocritical Care Specialist, 15 years experience.
• “The 21-day course is a commitment, but the neurological benefits for appropriate SAH patients are clear. The ability to administer via NG tube is crucial for intubated patients.” – Clinical Pharmacist, Major Stroke Center.
• “While newer endovascular treatments have emerged, nimodipine remains the standard of care pharmacological prophylaxis. Its cerebroselective profile is its key advantage.” – Vascular Neurosurgeon.
• “Requires diligent patient education upon discharge to ensure compliance with the full course and to warn about potential interactions, especially with common medications like certain antibiotics.” – Nurse Practitioner, Neurosurgery Clinic.