Nimotop (Nimodipine)

Nimodipine acts on the cerebrovascular system to reduce the risk of vessel narrowing after bleeding in the brain.

• Prevention of cerebral vasospasm following subarachnoid haemorrhage: helps maintain cerebral perfusion and reduces the incidence of delayed ischaemic neurological deficits.
• Adjunct in neurocritical care: supports overall management of patients at risk of secondary cerebral ischaemia after traumatic brain injury.
• Research settings involving cerebral blood flow modulation: used as a tool to study vascular responses in experimental protocols.

• Nimodipine selectively blocks L‑type calcium channels on vascular smooth muscle, especially within cerebral arteries. By inhibiting calcium influx, it induces vasodilation of intracranial vessels, improves cerebral blood flow, and provides neuroprotective effects against calcium‑mediated neuronal injury after subarachnoid haemorrhage.

Nimodipine may cause a range of adverse reactions, most of which are related to its vasodilatory action and systemic exposure.

Common Side Effects

• Headache: mild to moderate, often transient.
• Hypotension: reduction in systemic blood pressure, especially with rapid infusion.
• Nausea or vomiting: gastrointestinal discomfort.

Serious or Rare Side Effects

• Severe hypotension leading to syncope or organ hypoperfusion.
• Cardiac arrhythmias, including bradycardia.
• Hepatic dysfunction manifested by elevated transaminases.
• Anaphylactic or severe allergic reactions requiring immediate medical attention.

Before initiating Nimodipine therapy, clinicians should consider several safety measures.

• Blood pressure monitoring: observe for hypotension during and after infusion.
• Hepatic function: avoid or adjust dose in patients with significant liver impairment.
• Concomitant vasodilators: use caution when combined with other agents that lower blood pressure.
• Infusion rate: administer slowly to minimise rapid drops in systemic pressure.
• Known hypersensitivity: discontinue if allergic reaction occurs.
• Store at room temperature: keep in original container, protect from moisture and direct sunlight.

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

Major Interactions (Avoid)

• Other calcium channel blockers: additive vasodilatory effect may cause profound hypotension.
• Potent CYP3A4 inhibitors (e.g., ketoconazole, clarithromycin): increase plasma concentrations, raising toxicity risk.
• Concurrent strong vasodilators (e.g., nitroglycerin): may precipitate severe blood pressure falls.

Moderate Interactions (Monitor Closely)

• CYP3A4 inducers (e.g., rifampicin, carbamazepine): may reduce therapeutic levels.
• Beta‑blockers: combined effect on heart rate and blood pressure requires observation.
• Diuretics: may enhance orthostatic hypotension, necessitating dose adjustments.