nimodipine

CLINICAL USE

Calcium-channel blocker:Prevention and treatment of ischaemic neurological deficits following subarachnoid haemorrhage

DOSE IN NORMAL RENAL FUNCTION

Prevention: 60 mg orally every 4 hours Treatment via central catheter: 1 mg/hour initially, increased after 2 hours to 2 mg/hour. If BP unstable, weight <70 kg, start with 0.5 mg/hour or less if necessary

PHARMACOKINETICS

Molecular weight :418.4

%Protein binding :98

%Excreted unchanged in urine : <1

Volume of distribution (L/kg) :0.9–1.6

half-life – normal/ESRD (hrs) :1.1–1.7/22

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20 to 50 : Dose as in normal renal function

10 to 20 : Dose as in normal renal function

<10 : Dose as in normal renal function

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD :Not dialysed. Dose as in normal renal function

HD :Not dialysed. Dose as in normal renal function

HDF/high flux :Unknown dialysability. Dose as in normal renal function

CAV/VVHD :Unknown dialysability. Dose as in normal renal function

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugs

Anaesthetics: enhanced hypotensive effect

Antibacterials: metabolism accelerated by rifampicin

Anti-epileptics: effect reduced by carbamazepine, barbiturates, phenytoin and primidone

Antifungals: metabolism possibly inhibited by itraconazole and ketoconazoleAntihypertensives: enhanced hypotensive effect, increased risk of first dose hypotensive effect of post-synaptic alpha-blockers

Antivirals: concentration possibly increased by ritonavir

Grapefruit juice: concentration increased – avoid concomitant useTheophylline: possibly increased theophylline concentration

ADMINISTRATION

Reconstition

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Route

Oral, IV

Rate of Administration

IV – First 2 hours: 1 mg (5 mL) nimodipine per hourAfter 2 hours: Infuse 2 mg (10 mL) —nimodipine per hour

Comments

Nimodipine solution must not be added to an infusion bag or bottle and must not be mixed with other drugsNimodipine solution should be administered only via a bypass into a running drip (40 mL/hour) of either sodium chloride 0.9% or glucose 5%In the event of nimodipine tablets and solution being administered sequentially, the total duration of treatment should not exceed 21 days

OTHER INFORMATION

Nimodipine solution reacts with PVC. Polyethylene tubes are suppliedPatients with known renal disease and/or receiving nephrotoxic drugs should have renal function monitored closely during IV treatment.

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