Nimodipine drug information

For

• Patients
• Staff

Drug and brand names

• Nimotop

Formulations

• Film coated tablet (strength 30 mg)

Uses

• Nimodipine is indicated for the prevention of neurological problems caused by lack of oxygen to areas of the brain following an aneurysmal subarachnoid haemorrhage (SAH). A SAH is a bleed (haemorrhage) in and around the brain.
• Nimodipine is only recommended for patients who have experienced a brain bleed due to a spontaneous event. Most bleeds are due to a ruptured cerebral aneurysm (this is when the wall of an artery or blood vessel in the brain has weakened). The pressure of blood flow within this blood vessel causes the weakened wall to swell outwards and at worst, cause a rupture. Other causes of a spontaneous brain bleed can be from an arteriovenous malformation (AVM). An AVM is a tangle of blood vessels that can weaken and cause a brain bleed.
• Nimodipine is routinely given for a total 21 day course. This course will begin as soon as possible within four days of the brain bleed. However, please note, the course may be stopped earlier if you are unable to tolerate this medication (for example, if your blood pressure falls too low).
• Note: Nimodipine is not recommended for patients who have suffered a brain bleed due to trauma (for example, a road traffic accident) or a non-aneurysmal event.

How does my medication work?

Nimodipineis in a drug class known as the ‘calcium channel blockers’. Within this drug class, nimodipine exerts in particular effects on vessels within the brain.

Nimodipine helps to increase blood flow to the brain, particularly in poorly perfused areas, by dilating small blood vessels.

This medication also helps to reduce constriction of these blood vessels (vasoconstriction) which can be provoked after a brain haemorrhage occurs. It is important to avoid vasoconstriction as vessels in sudden contraction (vasospasm) can close down, resulting in not enough blood to healthy brain tissue. This can risk brain damage and vasospasm is considered a serious complication of SAH.

Approximately one third of patients suffering a SAH will experience vasospasm. Nimodipine works extremely well to help reduce this risk. If nimodipine has been prescribed for you, it is important you do not miss this medication and that you complete the full intended course, unless otherwise advised by your neurosurgeon or specialist neurosurgery nurse.

Side effects (this list is not exhaustive, please also refer to product literature)

In general, nimodipine is tolerated very well by patients. However, as with all medication, there is always a risk of side effects, though it is unlikely that you will experience these. Please alert your prescriber if you notice any new adverse effect straight after first starting nimodipine so this can be assessed.

Side effects of nimodipine can include low blood platelet count (thrombocytopenia – signs of this can include abnormal bleeding or bruising), rash, allergic reaction, headache, a fast pulse (tachycardia), low blood pressure (hypotension), dizziness and nausea.

Rarely, this medication can also affect liver enzymes, cause a slow pulse (bradycardia) and ileus (lack of movement within the intestines that can lead to an obstruction).

If you notice any of the above symptoms during your treatment, alert your neurosurgeon or specialist neurosurgery nurse as soon as possible so this can be urgently assessed.

Please note there are signs / symptoms that you may experience due to your clinical event (SAH) rather than your medication. More information on this is provided below.

It is important to understand recovery from a SAH varies vastly between individuals. Some symptoms during recovery from a SAH can include:

• headaches
• sleepiness
• restlessness
• feeling emotional, overwhelmed or anxious
• difficulties with memory and problems with thinking, decision making and concentration

It is also important to be aware of possible signs of vasospasm following a SAH. These include:

• weakness in an arm or leg
• confusion
• restlessness
• sleepiness
• difficulty with speaking
• trouble seeing
• severe headache

Please ensure any of the above possible signs or symptoms of vasospasm experienced are reported as a matter of urgency to your neurosurgeon or specialist neurosurgery nurse.

Contraception

In single cases involving in-vitro fertilisation calcium channel blockers (as a whole drug class) have been associated with reversible biochemical changes to sperm which may result in impaired sperm function. Unfortunately, there is not enough evidence within studies to confirm safety of nimodipine in this setting. It is recommended you and your partner ensure adequate effective contraception whilst you are on nimodipine.

Pregnancy and breastfeeding

There are no adequate studies in pregnant women. Studies in animals have indicated reproductive toxicity, but toxicology studies have indicated no teratogenic effect. If nimodipine is to be administered in pregnancy, your clinician will help you understand the benefits for you and potential risks to your unborn baby according to the severity of the clinical picture.

Nimodipine does transfer into human milk at unspecified concentrations. Nursing mothers are advised not to breast feed when taking this drug. If you wish to breast feed whilst taking nimodipine, please discuss this with your prescriber.

Drug interactions

• Concurrent use of nimodipine with phenobarbital, primidone, carbamazepine or phenytoin is contraindicated. These epilepsy medications decrease the concentration of nimodipine causing it to be less effective.
• ECG monitoring is advised if nimodipine is to be given alongside lacosamide.
• Certain HIV medications (HIV protease inhibitors, such as, ritonavir) can increase nimodipine exposure and risk adverse effects (low blood pressure, swelling, headache). If nimodipine is used alongside these medications, adverse effects must be monitored.
• Blood pressure can sometimes sharply reduce when nimodipine is taken by patients already on alpha blocker medication (for example, tamsulosin). If this occurs, you should lie down if dizziness, fatigue or sweating develops and remain in this position until symptoms resolve. Please alert your neurosurgeon or specialist neurosciences nurse if these symptoms arise.

Other useful information

• The tablets should be swallowed whole with a little liquid, with or without food.
• Nimodipine can be safely taken alongside simple pain relief (such as paracetamol and codeine). Strong pain relief such as oxycodone should be avoided, due to their sedative action, which can be dangerous in this condition.
• Nimodipine is not recommended for patients during or within one month of suffering a heart attack or an episode of unstable angina.
• Nimodipine must be used with caution when blood pressure is low (systolic <100mmHg).
• Nimodipine tablets should be stored below 30°C, in a clean, dry, safe place.
• Nimodipine should not be put into a compliance aid (dosette box) as it is extremely light sensitive, and its effectiveness can be reduced if held in such aids.
• It is safe for nimodipine tablets to be crushed and administered immediately via enteral feeding tube (if this route is applicable).
• Alongside taking your nimodipine, there are three most effective long-term steps you can take to reduce your risk of having a further SAH, these include:
  • stopping smoking
  • having regular blood pressure checks
  • moderating your consumption of alcohol

Contact details

If you have any questions or concerns, please contact the specialist neurosurgery nurses between Monday and Friday on 01223 216189.

The information on this leaflet is not exhaustive. Please refer to the patient information leaflet prepared by the manufacturer of your drug which can be found in the medicine packaging.