THERAPEUTICS

Brands

• Nymalize, Nimotop

Generic?

• Yes

Class

• Calcium channel blocker

Commonly Prescribed for

(FDA approved in bold)

• Reduce the incidence and severity of ischemic deficits in adult patients with subarachnoid hemorrhage (SAH) from ruptured intracranial berry aneurysms regardless of their post-ictus neurological condition (i.e., Hunt and Hess Grades I–V)

• Hypertension

• Traumatic brain injury

• Reversible cerebral vasoconstrictive syndromes (RCVS)

How the Drug Works

• Cardiac and vascular smooth muscle contraction depends on movement of calcium through L-type calcium channels, which is inhibited by nimodipine. In animals, nimodipine has a greater effect on cerebral arteries compared with other calcium channel blockers, probably because it is more lipophilic. There is no angiographic evidence that this is correct

How Long Until It Works

• Within hours for both SAH vasospasm and hypertension

If It Works

• Prevents delayed ischemic complications after SAH caused by vasospasm, improves recovery time, and reduces disability

• Typically used for 3 weeks

If It Doesn't Work

• Continue supportive care

Best Augmenting Combos for Partial Response or Treatment-Resistance

• Treatment of SAH should take place in a medical center with experience and 24-hour physician availability

• Occlude the aneurysm in SAH by surgery or coiling

• Do not treat hypertension aggressively

• Normovolemia is preferred

• Treat hyperglycemia and use measures to avoid deep vein thrombosis

Tests

• Monitor blood pressure and heart rate

ADVERSE EFFECTS (AEs)

How the Drug Causes AEs

• Direct effects of L-type calcium receptor antagonism on cardiac and smooth muscle

Notable AEs

• Hypotension, bradycardia

• Flushing, headache, constipation, nausea, myalgia, edema

Life-Threatening or Dangerous AEs

• Rare elevation of hepatic transaminases or thrombocytopenia

• May slow AV conduction or worsen symptoms of heart failure

Weight Gain

• Unusual

Sedation

• Unusual

What to Do About AEs

• Complications of SAH are more serious than significant AEs due to nimodipine. Continue or lower dose