Nimotop (Nimodipine)

Nimodipine acts on cerebral arterial smooth muscle to prevent and treat vasospasm after subarachnoid hemorrhage.

• Subarachnoid hemorrhage (SAH): reduces incidence and severity of cerebral vasospasm, supporting neurological recovery.
• Aneurysmal SAH postoperative care: helps maintain cerebral perfusion during the critical post‑procedure period.
• Neurosurgical patients at risk of vasospasm: provides prophylactic vasodilation to limit secondary ischemic injury.

• Nimodipine selectively blocks L‑type calcium channels in the smooth muscle of cerebral arteries. By inhibiting calcium influx, it induces vasodilation, lowering arterial tone and preventing the constriction that leads to vasospasm. The drug’s preferential action in the cerebral circulation preserves blood flow without markedly affecting systemic vascular resistance, contributing to its neuroprotective profile.

Nimodipine may cause a range of adverse reactions, most of which are mild and transient.

Common Side Effects

• Headache
• Flushing
• Nausea
• Dizziness

Serious or Rare Side Effects

• Severe hypotension
• Cardiac arrhythmia
• Hepatic enzyme elevation

When prescribing Nimodipine, clinicians should observe several precautionary measures to ensure patient safety.

• Blood pressure monitoring: check systolic and diastolic values before and during therapy.
• Concomitant CYP3A4 inhibitors: avoid strong inhibitors such as ketoconazole or clarithromycin.
• Hepatic impairment: use with caution and consider dose adjustment in patients with liver dysfunction.
• Pregnancy and lactation: assess risk‑benefit ratio before use in pregnant or breastfeeding women.
• Abrupt discontinuation: taper gradually to prevent rebound vasospasm.
• Store at ambient temperature: keep in original packaging, protect from moisture and light.

Nimodipine can interact with other medicines, altering its effectiveness or safety profile.

Major Interactions (Avoid)

• Strong CYP3A4 inhibitors (e.g., ketoconazole, clarithromycin): may increase plasma levels and risk of toxicity.
• Concurrent potent vasodilators (e.g., other calcium channel blockers, nitroglycerin): can cause excessive hypotension.

Moderate Interactions (Monitor Closely)

• CYP3A4 inducers (e.g., rifampin, carbamazepine): may reduce therapeutic concentrations.
• Beta‑blockers: additive effects on heart rate and blood pressure.
• Diuretics: may enhance hypotensive response.
• NSAIDs: may blunt antihypertensive effect.