Nymalize (nimodipine) dosing, indications, interactions, adverse effects, and more

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Sections nimodipine
Dosing & Uses
Interactions
Adverse Effects
Warnings
Pregnancy
Pharmacology
Administration
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Formulary

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

gel capsule

30 mg

oral solution (Nymalize)

30 mg/10 mL
60mg/20 mL

Subarachnoid Hemorrhage

Indicated for the improvement of neurological outcome by reducing the incidence and severity of ischemic deficits with subarachnoid hemorrhage from ruptured intracranial berry aneurysms regardless of their postictus neurological condition (ie, Hunt and Hess Grades I-V)

60 mg PO q4hr for 21 days; begin therapy within 96 hours of subarachnoid hemorrhage

Dosage Modifications

Renal impairment: Supplemental dose not necessary in hemodialysis or peritoneal dialysis

Hepatic impairment: Decrease dose to 30 mg (10mL) PO q4hr; closely monitor BP and HR

Subarachnoid Hemorrhage (Orphan)

New dosage form

Orphan designation for intraventricular injection for treatment of subarachnoid hemorrhage

Sponsor

Edge Therapeutics, Inc; 211 Warren Street, Newark, NJ 07103

Safety and efficacy not established

Interaction Checker

Enter a drug name and nimodipine

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Interactions Found

Contraindicated

Serious - Use Alternative

Significant - Monitor Closely

Minor

All Interactions Sort By:

1-10%

Reduction in systemic blood pressure (1-8%)

Diarrhea (2-4%)

Headache (1-4%)

Abdominal discomfort (2%)

Rash (1-2%)

<1%

Heart failure

Arrhythmia

Anemia

ECG abnormalities

GI hemorrhage

Hepatitis

Jaundice

Thrombocytopenia

Vomiting

Thrombosis

Rebound vasospasm

Black Box Warnings

Do not administer contents of gel capsule or oral solution IV or by other parenteral routes

Deaths and serious life-threatening adverse events (ie, significant hypotension requiring pressor support) have occurred when injected parenterally

Contraindications

Hypersensitivity

Parenteral administration; risk of death (see Black Box Warnings)

Cautions

Congestive heart failure

Reflex tachycardia resulting in angina and/or MI in patients with obstructive coronary disease reported

Metabolism decreased in patients with hepatic impairment

Use caution in hepatic impairment or hypertrophic subaortic stenosis

Peripheral edema may occur within 2-3 weeks of initiating therapy

Hypotension with or without syncope is possible (particularly with severe aortic stenosis)

Intestinal pseudo-obstruction and ileus have been reported rarely

A decreased dose may be required with strong CYP3A4 inhibitors

Pregnancy & Lactation

Pregnancy Category: C

Lactation: unknown; avoid

Pregnancy Categories

A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

NA: Information not available.

Mechanism of Action

Ca channel blocker with minimal effects on conduction in heart; primary effect is upon cerebral arteries to prevent vasospasm

Highly lipophilic, allowing it to cross the blood-brain barrier

Absorption

Bioavailability: 13%

Peak Plasma Time: 1 hr

Peak Plasma Concentration: 80 ng/mL

Distribution

Protein Bound: 95%

Vd: 0.43 L/kg

Metabolism

Hepatic P450 enzyme CYP3A4

Elimination

Half-Life: 1-2 hr

Total Body Clearance: 0.84 L/kg (healthy); 1.18 L/kg (SAH)

Excretion: Urine (50%); feces (32%)

Instructions

Gel capsule: Swallow capsule whole; if unable to swallow, may withdraw liquid content out with syringe and administer PO

Oral solution: Administer only enterally (eg, oral, nasogastric tube, or gastric tube route); for each dose, refill the syringe with 20 mL of 0.9% NaCl and then flush any remaining contents from NG or gastric tube into the stomach

Do not administer gel capsule contents or oral solution IV or any other parenteral route (see Black Box Warnings)

Take at least 1 hr before or 2 hr after meals

Avoid grapefruit juice

Images

Patient Handout

Formulary

FormularyPatient Discounts

Adding plans allows you to compare formulary status to other drugs in the same class.

To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

Create Your List of Plans

Adding plans allows you to:

View the formulary and any restrictions for each plan.
Manage and view all your plans together – even plans in different states.
Compare formulary status to other drugs in the same class.
Access your plan list on any device – mobile or desktop.

The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

View explanations for tiers and restrictions

Tier	Description
1	This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
2	This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
3	This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
4	This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
5	This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
6	This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
NC	NOT COVERED – Drugs that are not covered by the plan.

Code	Definition
PA	Prior Authorization Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
QL	Quantity Limits Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
ST	Step Therapy Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
OR	Other Restrictions Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.

Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.

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Sections nimodipine
Dosing & Uses
Interactions
Adverse Effects
Warnings
Pregnancy
Pharmacology
Administration
Images
Patient Handout
Formulary

nimodipine (Rx)