Nimotop
nimodipine
Pharmacologic class: Calcium channel blocker
Therapeutic class: Cerebral vasodilator
Pregnancy risk category C
FDA Box Warning
Don't give by I.V. or other parenteral route. Deaths and serious or life-threatening adverse events have occurred when capsule contents have been injected parenterally.
Action
Inhibits calcium transport into vascular smooth muscle cells, suppressing contractions; also dilates coronary and cerebral arteries
Availability
Capsules: 30 mg
Indications and dosages
➣ Subarachnoid hemorrhage
Adults: 60 mg P.O. q 4 hours for 21 days. Therapy should start within 96 hours of subarachnoid hemorrhage.
Dosage adjustment
• Hepatic impairment
Contraindications
None
Precautions
Use cautiously in:
• hepatic impairment, hypotension
• elderly patients
• pregnant or breastfeeding patients (safety not established)
• children (safety not established).
Administration
• Give at least 1 hour before or 2 hours after meals. Don't let patient consume grapefruit or grapefruit juice within 1 hour before or 2 hours after dose.
• If patient can't swallow capsule, puncture it with sterile needle and empty contents into syringe. Administer through nasogastric tube, then flush with normal saline solution (30 ml).
Adverse reactions
CNS: headache, depression
CV: hypotension, peripheral edema, ECG abnormalities, bradycardia, tachycardia
GI: nausea, diarrhea, abdominal discomfort
Musculoskeletal: muscle cramps
Respiratory: dyspnea
Skin: acne, flushing, rash
Interactions
Drug-drug. Other calcium channel
blockers: enhanced cardiovascular effects
Drug-diagnostic tests. Liver function
tests: abnormal results
Drug-food. Any food: decreased drug blood level and effects
Grapefruit juice, grapefruit juice: increased drug blood level and effects
Drug-herbs. Ephedra (ma huang),
yohimbine: antagonism of nimodipine effects
St. John's wort: decreased drug blood level
Drug-behaviors. Alcohol use: increased hypotension
Patient monitoring
• Monitor weight and fluid intake and output. Stay alert for fluid retention.
• Assess neurologic status and mood, watching for signs of depression.
• Check vital signs and ECG.
Patient teaching
• Tell patient to complete full course of therapy (21 days).
• Advise patient to take on an empty stomach 1 hour before or 2 hours after a meal. Instruct him to not to consume grapefruit or grapefruit juice within 1 hour before or 2 hours after taking drug.
• Tell patient to report irregular heartbeat, shortness of breath, rash, or swollen hands or feet.
• Instruct patient to minimize GI upset by eating small, frequent meals.
• Advise patient to weigh himself daily and report sudden weight gain.
• As appropriate, review all other significant adverse reactions and interactions, especially those related to the drugs, tests, foods, herbs, and behaviors mentioned above.
niMODipine
(nye-moe-di-peen) nimodipine,Nimotop
(trade name),Nymalize
(trade name)Classification
Therapeutic: subarachnoid hemorrhage therapy agentsPharmacologic: calcium channel blockers
Indications
Action
Therapeutic effects
Pharmacokinetics
Time/action profile (vasodilation)
| ROUTE | ONSET | PEAK | DURATION |
|---|---|---|---|
| PO | unknown | 1 hr | 4 hr |
Contraindications/Precautions
Adverse Reactions/Side Effects
Central nervous system
- abnormal dreams
- anxiety
- confusion
- dizziness
- drowsiness
- headache
- nervousness
- psychiatric disturbances
- weakness
Ear, Eye, Nose, Throat
- blurred vision
- disturbed equilibrium
- epistaxis
- tinnitus
Respiratory
- cough
- dyspnea
Cardiovascular
- arrhythmias (life-threatening)
- HF (life-threatening)
- chest pain
- hypotension
- palpitations
- peripheral edema
- syncope
- tachycardia
Gastrointestinal
- ↑ liver enzymes
- anorexia
- constipation
- diarrhea
- dry mouth
- dysgeusia
- dyspepsia
- nausea
- vomiting
Genitourinary
- dysuria
- nocturia
- polyuria
- sexual dysfunction
- urinary frequency
Dermatologic
- dermatitis
- erythema multiforme
- flushing
- ↑ sweating
- photosensitivity
- pruritus/urticaria
- rash
Endocrinologic
- gynecomastia
- hyperglycemia
Hematologic
- anemia
- leukopenia
- thrombocytopenia
Metabolic
- weight gain
Musculoskeletal
- joint stiffness
- muscle cramps
Neurologic
- paresthesia
- tremor
Miscellaneous
- stevens-johnson syndrome (life-threatening)
- gingival hyperplasia
Interactions
Drug-Drug interaction
Strong CYP3A4 inhibitors, including clarithromycin, telithromycin, indinavir, nelfinavir, ritonavir, saquinavir, boceprevir, telaprevir, ketoconazole, itraconazole, posaconazole, voriconazole, conivaptan, and nefazodone may ↑ levels and the risk of hypotension; avoid concurrent useStrong CYP3A4 inducers, including carbamazepine, phenobarbital, phenytoin, and rifampin may ↓ levels and effects; avoid concurrent useAdditive hypotension may occur when used concurrently with fentanyl, other antihypertensives, nitrates, acute ingestion of alcohol, or quinidine.St. John's wort may ↓ levels and effect; avoid concurrent useGrapefruit and grapefruit juice ↑ levels and effect; avoid concurrent use.Route/Dosage
Hepatic Impairment
Oral (Adults) 30 mg every 4 hr for 21 days; therapy should be started within 96 hr of subarachnoid hemorrhage.Availability (generic available)
Nursing implications
Nursing assessment
- Assess patient’s neurologic status (level of consciousness, movement) prior to and periodically following administration.
- Monitor BP and pulse prior to therapy and periodically during therapy.
- Monitor intake and output ratios and daily weight. Assess for signs of HF (peripheral edema, rales/crackles, dyspnea, weight gain, jugular venous distention).
- Assess for rash periodically during therapy. May cause Stevens-Johnson syndrome. Discontinue therapy if severe or if accompanied with fever, general malaise, fatigue, muscle or joint aches, blisters, oral lesions, conjunctivitis, hepatitis, and/or eosinophilia.
- Lab Test Considerations: Total serum calcium concentrations are not affected by calcium channel blockers.
- Monitor serum potassium periodically. Hypokalemia ↑ risk of arrhythmias; should be corrected.
- Monitor renal and hepatic functions periodically. Several days of therapy may cause ↑ hepatic enzymes, which return to normal upon discontinuation of therapy.
- May occasionally cause ↓ platelet count.
Potential Nursing Diagnoses
Ineffective tissue perfusion (Indications)Implementation
- Do not confuse nimodipine with nicardipine or nifedipine.
- Begin administration within 96 hr of subarachnoid hemorrhage and continue every 4 hr for 21 consecutive days.
- Administer by PO route ONLY; when administered IV or parenterally, may cause serious adverse events, including death.
- Oral: If patient is unable to swallow capsule, make a hole in both ends of the capsule with a sterile 18-gauge needle and extract the contents into a syringe. Empty contents into water or nasogastric tube and flush with 30 mL normal saline.
- Administer oral solution 1 hr before or 2 hr after meals. For administration via NG or gastric tube, administer via syringe included, then refill syringe with 20 mL of 0.9% saline water solution; flush remaining contents from NG or gastric tube into stomach.
Patient/Family Teaching
- Advise patient to take medication as directed, even if feeling well. Take missed doses as soon as possible unless almost time for next dose; do not double doses. May need to be discontinued gradually.
- Advise patient to avoid grapefruit or grapefruit juice during therapy.
- Caution patient to change positions slowly to minimize orthostatic hypotension.
- May cause drowsiness or dizziness. Advise patient to avoid driving or other activities requiring alertness until response to the medication is known.
- Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to avoid concurrent use of alcohol or OTC medications and herbal products, especially cold preparations, without consulting health care professional.
- Advise patient to notify health care professional if rash, irregular heartbeats, dyspnea, swelling of hands and feet, pronounced dizziness, nausea, constipation, or hypotension occurs or if headache is severe or persistent.
- Caution patient to wear protective clothing and use sunscreen to prevent photosensitivity reactions.
- Advise female patient to notify health care professional if pregnancy is planned or suspected or if breast feeding.
Evaluation/Desired Outcomes
- Improvement in neurologic deficits due to vasospasm following subarachnoid hemorrhage.