Nimodipine has inadvertently been administered IV when withdrawn from capsules into a syringe for subsequent nasogastric administration. Severe cardiovascular adverse events, including fatalities, have resulted; precautions eg, adequate labeling, use of oral syringes should be employed against such an event. Hadjiev D, Velcheva I, Ivanova L. Nimodipine in the treatment of headache in chronic cerebral ischemia. Cephalalgia. Measure your dose with a marked measuring spoon, oral syringe, or medicine cup. Elderly patients have been found to have 2 to 3 fold higher plasma concentrations C max and AUC than young subjects.
Use of nimodipine to treat preeclampsia has been reported in small studies. In one study, nimodipine 30 mg was given every 4 hours from admission to 24 hours after delivery to 10 consecutive women with preeclampsia. If you miss a dose of nimodipine oral solution, take it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once. Fosphenytoin: Calcium Channel Blockers may increase the serum concentration of Fosphenytoin. Management: Monitor for phenytoin toxicity with concomitant use of a calcium channel blocker CCB or decreased phenytoin effects with CCB discontinuation. Monitor for decreased CCB therapeutic effects. Nimodipine Canadian labeling contraindicates use with phenytoin.
Peripheral edema: The most common side effect is peripheral edema; occurs within 2 to 3 weeks of starting therapy. Use with caution. The effects may be increased because of slower removal of the medicine from the body. Andrea G et al. Nimodipine versus flunarizine in common migraine: a controlled pilot trial. Headache. Conivaptan: May increase the serum concentration of CYP3A4 Substrates. Deyo RA, Straube KT, Disterhoft JF. Nimodipine facilitates associative learning in aging rabbits. Science.
Naftopidil: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Nimodipine oral solution may cause dizziness, light-headedness, or fainting; alcohol, hot weather, exercise, or fever may increase these effects. To prevent them, sit up or stand slowly, especially in the morning. Sit or lie down at the first sign of any of these effects. Factors identified by FDA as contributing to this error include use of IV syringes to administer the drug by NG tube IV syringes sometimes are used to remove the liquid contents from the capsules and the fact that most patients receiving the drug are in critical care settings and are receiving other IV therapy.
Auer LM, Oberbauer RW, Schalk HV. Human pial vascular reactions to intravenous nimodipine-infusion during EC-IC bypass surgery. Stroke. Perkins CM. Serious verapamil poisoning: treatment with intravenous calcium gluconate. CloZAPine: CYP1A2 Inhibitors Weak may increase the serum concentration of CloZAPine. The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine. Ljunggren B, Brandt L, Saveland H et al. Outcome in 60 consecutive patients treated with early aneurysm operation and intravenous nimodipine. J Neurosurg. This medication may make you more sensitive to the sun. Limit your time in the sun. Avoid tanning booths and sunlamps. Use and wear protective clothing when outdoors. Dabrafenib: May decrease the serum concentration of CYP3A4 Substrates. Management: Seek alternatives to the CYP3A4 substrate when possible. If concomitant therapy cannot be avoided, monitor clinical effects of the substrate closely particularly therapeutic effects. Nimodipine is a yellow crystalline substance, practically insoluble in water. Mohamed AA, Mendelow AD, Teasdale GM et al. Effect of the calcium antagonist nimodipine on local cerebral blood flow and metabolic coupling. J Cereb Blood Flow Metab. Mickisch G, Keilhauer G, Schlick E et al. Calcium antagonists reverse multidrug resistance MDR of primary human renal cell carcinomas RCC. Proc Annu Meet Am Assoc Cancer Res. Quinagolide: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Moroni F, Mannaioni PF, Dolara A et al. Calcium gluconate and hypertonic sodium chloride in a case of massive verapamil poisoning. Clin Toxicol. Haitas B, Joffe BI, Edelstein D et al. Calcium antagonists nifedipine and nimodipine and pituitary responses to thyrotropin releasing hormone stimulation. J Cardiovasc Pharmacol. At least 3 days should be allowed before increasing the dose to assure steady state levels.
Auer LM. Acute operation and preventive nimodipine improve outcome in patients with ruptured cerebral aneurysms. Neurosurgery. Simeprevir: May increase the serum concentration of CYP3A4 Substrates. Palbociclib: May increase the serum concentration of CYP3A4 Substrates. Brandt L, Saveland H, Ljunggren B et al. Control of epilepsy partialis continuans with intravenous nimodipine. J Neurosurg. Rapidly 1 46 85 89 213 and almost completely 4 5 213 absorbed following oral administration, with peak concentrations attained within 1 hour. Nicergoline: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Some MEDICINES MAY INTERACT with nimodipine oral solution. CycloSPORINE Systemic: Calcium Channel Blockers Dihydropyridine may increase the serum concentration of CycloSPORINE Systemic. CycloSPORINE Systemic may increase the serum concentration of Calcium Channel Blockers Dihydropyridine. Hypotension-Associated Agents: Blood Pressure Lowering Agents may enhance the hypotensive effect of Hypotension-Associated Agents. Please refer to the for information on shortages of one or more of these preparations. Fine RL, Chabner BA. Multidrug resistance. Cancer Chemother.
Nisoldipine were not significantly different in patients with various degrees of renal impairment. Dosing adjustments in patients with mild to moderate renal impairment are not necessary. Mitotane: May decrease the serum concentration of CYP3A4 Substrates. Management: Doses of CYP3A4 substrates may need to be adjusted substantially when used in patients being treated with mitotane. Nitroglycerin is in a group of drugs called nitrates. Nitroglycerin dilates widens blood vessels, making it easier for blood to flow through them and easier for the heart to pump. Walley TJ, Woods KL, Barnett DB. Effects of calcium channel blockers on in vitro platelet function in whole blood using single platelet counting. Thromb Haemost. Macrolide Antibiotics: May decrease the metabolism of Calcium Channel Blockers. Management: Consider using a noninteracting macrolide. Felodipine Canadian labeling specifically recommends avoiding its use in combination with clarithromycin. Exceptions: Azithromycin Systemic; Fidaxomicin; Roxithromycin; Spiramycin. If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose and resume your usual dosing schedule.
Elderly: Initiate at a lower dose in the elderly. Capsules should be protected from light and freezing. ARIPiprazole: CYP3A4 Inhibitors Weak may increase the serum concentration of ARIPiprazole. Management: Monitor for increased aripiprazole pharmacologic effects. A297” in black ink. Hemodialysis or peritoneal dialysis not likely to affect elimination. Freedman DD, Waters DD. “Second generation” dihydropyridine calcium antagonists: greater vascular selectivity and some unique applications. Drugs.
Your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor or pharmacist first. It is best to take nimodipine at least 1 hour before or 2 hours after a meal. North American clinical trials. Kunert-Radek J, Stepien H, Radek A et al. Inhibitory effect of calcium channel blockers on proliferation of human glioma cells in vitro. Acta Neurol Scand. Snyder SH. Drug and neurotransmitter receptors in the brain. Science. Vinge E, Brandt L, Ljunggren B et al. Thromboxane B 2 levels in serum during continuous administration of nimodipine to patients with aneurysmal subarachnoid hemorrhage. Stroke. Enzalutamide: May decrease the serum concentration of CYP3A4 Substrates. Management: Concurrent use of enzalutamide with CYP3A4 substrates that have a narrow therapeutic index should be avoided. Use of enzalutamide and any other CYP3A4 substrate should be performed with caution and close monitoring. Belfort MA, Saade GR, Moise KJ, Cruz A, Adam K, Kramer W, Kirshon B "Nimodipine in the management of preeclampsia: maternal and fetal effects. Intestinal pseudo-obstruction and ileus responsive to conservative management has been reported rarely. No dosage adjustment is recommended based on age. Steady-state pharmacokinetics were similar between elderly greater than 65 years of age patients and young health subjects in clinical studies. However, caution is advised in dose selection because of a greater incidence of reduced organ function, concomitant disease, or drug therapy in the elderly. This drug may also be used to decrease problems due to stroke. Manufactured for: Atlanta, GA 30328. Roine RO, Kaste M, Kinnunen A et al. Nimodipine after resuscitation from out-of-hospital ventricular fibrillation: a placebo-controlled, double-blind, randomized trial. JAMA. Prostacyclin Analogues: May enhance the hypotensive effect of Blood Pressure Lowering Agents.
Nisoldipine does not appear to have significant negative inotropic activity in intact animals or humans, and did not lead to worsening of clinical heart failure in three small studies of patients with asymptomatic and symptomatic left ventricular dysfunction. There is little information, however, in patients with severe congestive heart failure, and all calcium channel blockers should be used with caution in any patient with heart failure. What happens if I miss a dose Nitrostat? Disclaimer: Every effort has been made to ensure that the information provided is accurate, up-to-date and complete, but no guarantee is made to that effect. In addition, the drug information contained herein may be time sensitive and should not be utilized as a reference resource beyond the date hereof. This material does not endorse drugs, diagnose patients, or recommend therapy. You will need to have your blood pressure measured during treatment with nimodipine. If you notice any changes to your recommended blood pressure, call your doctor right away. If you have questions about this, talk to your doctor. Laboratory Test Interactions: None known.
Barbiturates: May increase the metabolism of Calcium Channel Blockers. Management: Monitor for decreased therapeutic effects of calcium channel blockers with concomitant barbiturate therapy. Calcium channel blocker dose adjustments may be necessary. Nimodipine Canadian labeling contraindicates concomitant use with phenobarbital. Methylphenidate: May diminish the antihypertensive effect of Antihypertensive Agents. Gelmers HJ. Calcium-channel blockers in the treatment of migraine. Am J Cardiol. Messing RO, Carpenter CL, Greenberg DA. Mechanism of calcium channel inhibition by phenytoin: comparison with classical calcium channel antagonists. J Pharmacol Exp Ther. How often did hospital staff describe possible side effects in a way you could understand? Rarely, abnormal drug-seeking behavior is possible with this medication. not increase your dose, take it more frequently, or use it for a longer time than prescribed. Properly stop the medication when so directed. Dizziness, lightheadedness, or fainting may also occur while using nimodipine. Make sure you know how you react to nimodipine before you drive, use machines, or do anything else that could be dangerous if you are dizzy or not alert. If you feel dizzy, lie down so you do not faint. Then sit for a few moments before standing to prevent the dizziness from returning. Mania is a period of abnormally elevated mood and high energy, usually accompanied by erratic behavior lasting at least seven days at a time. Hypomania is an elevated mood not reaching full-blown mania a minimum of four days. Reduce dosage to 30 mg every 4 hours in patients with cirrhosis. For example, in one study of people with bipolar II disorder, the amount of time spent depressed was more than 35 times the amount of time spent hypomanic. Also, people often don't take note of their own hypomanic symptoms, mistaking them for a period of unusually good mood. How Is Bipolar Disorder with Rapid Cycling Treated? Nimodipine. A causal relationship has not been established. Takata Y, Kato H. Comparative study on acute antihypertensive effects and pharmacokinetics of nisoldipine, nifedipine, nimodipine and nicardipine administered orally to conscious renal hypertensive dogs. Arzneimittelforschung. Additionally, TRUVEN HEALTH MAKES NO REPRESENTATION OR WARRANTIES AS TO THE OPINIONS OR OTHER SERVICE OR DATA YOU MAY ACCESS, DOWNLOAD OR USE AS A RESULT OF USE OF THE THOMSON REUTERS HEALTHCARE PRODUCTS. ALL IMPLIED WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE OR USE ARE HEREBY EXCLUDED. Truven Health does not assume any responsibility or risk for your use of the Truven Health products. Possible decreased systemic BP; 1 decreases generally are not marked with usual oral dosages. Ohman J, Heiskanen O. Effect of nimodipine on the outcome of patients after aneurysmal subarachnoid hemorrhage and surgery. J Neurosurg.
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Onoda JM, Sloane BF, Honn KV. Antithrombogenic effects of calcium channel blockers: synergism with prostacyclin and thromboxane synthase inhibitors. Thromb Res. AHFS drug information 2006. McEvoy GK, ed. Nimodipine. This medication can cause unusual results with certain medical tests. Tell any doctor who treats you that you are using nitroglycerin.
Ljunggren B, Saveland H, Brandt L. Causes of unfavorable outcome after early aneurysm operation. Neurosurgery. Hansten PD, Horn JR. Drug interactions: clinical significance of drug-drug interactions. Aprepitant: May increase the serum concentration of CYP3A4 Substrates. Scriabine A, Schuurman T, Traber J. Pharmacological basis for the use of nimodipine in central nervous system disorders.
Grapefruit Juice: May increase the serum concentration of AmLODIPine. Russell RP. Side effects of calcium channel blockers. Hypertension. Brandt L, Ljunggren B, Saveland H et al. Cerebral vasospasm and calcium channel blockade. Nimodipine treatment in patients with aneurysmal subarachnoid hemorrhage. Acta Pharmacol Toxicol Copenh. Consult your doctor before -feeding.
CYP3A4 Inducers Strong: May increase the metabolism of CYP3A4 Substrates. Management: Consider an alternative for one of the interacting drugs. Some combinations may be specifically contraindicated. Consult appropriate manufacturer labeling. Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking nimodipine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.