Nimodipine

Nimodipine - a calcium channel blocker with smooth muscle relaxant effect preferentially in the cerebral arteries. Its use is confined to prevention of vascular spasm after subarachnoid haemorrhage. Nimodipine is used in conjunction with the ‘triple H’ regimen of hypertension,hypervolaemia and haemodilution to a haematocrit of 30–33.

Uses
Subarachnoid haemorrhage

Administration
• IV infusion

1 mg/h, to 2 mg/h if BP not severely ↓ If <70 kg or BP unstable start at 0.5 mg/h Ready prepared solution do not dilute, but administer into a running infusion (40 ml/h) of sodium chloride 0.9% or glucose 5%, via a central line
Continue for between 5 and 14 days
Use only polyethylene or polypropylene infusion sets
Protect from light
10 mg in 50-ml vial (0.02%)
0.5 mg/h = 2.5 ml/h
1 mg/h = 5 ml/h
2 mg/h = 10 ml/h

• Orally (prophylaxis)
  60 mg every 4 hours for 21 days

How not to use nimodipine
Avoid PVC infusion sets
Do not use peripheral venous access
Do not give nimodipine tablets and IV infusion concurrently
Avoid concurrent use of other calcium-channel blockers, B-blockers or
nephrotoxic drugs

Adverse effects
Hypotension (vasodilatation)
Transient liver enzymes with IV use

Cautions
Hypotension (may be counterproductive by ↓ cerebral perfusion)
Cerebral oedema or severely ↑ ICP
Renal impairment