From the Guidelines
Nimodipine should be administered at a dose of 60 mg orally every 4 hours for 21 days to improve outcomes in patients with subarachnoid hemorrhage. This recommendation is based on the most recent guideline from the American Heart Association/American Stroke Association, published in 2023 1. The study emphasizes the importance of consistent administration of nimodipine to prevent cerebral vasospasm and improve patient outcomes.
- Key points to consider when administering nimodipine include:
- Starting the medication within 96 hours of the hemorrhage for maximum benefit
- Monitoring blood pressure, especially in patients with existing low blood pressure or those taking other antihypertensive medications, as nimodipine can cause hypotension
- Considering dose adjustments in patients with hepatic impairment, as nimodipine is metabolized in the liver
- Using alternative administration methods, such as extracting the liquid contents of the capsule and administering through a nasogastric tube, for patients who cannot swallow
- It is essential to note that while intravenous and intra-arterial routes of nimodipine administration have been reported, there is limited data to support their use, and the oral form remains the primary recommended route 1.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION ... The recommended oral dose is 60 mg (two 30 mg capsules) every 4 hours for 21 consecutive days.
... Dosage should be reduced to one 30 mg capsule every 4 hours with close monitoring of blood pressure and heart rate; if necessary, discontinuation of the treatment should be considered.
The dose of nimodipine is 60 mg (two 30 mg capsules) every 4 hours for 21 consecutive days. However, in patients with severely disturbed liver function, the dose should be reduced to 30 mg (one 30 mg capsule) every 4 hours with close monitoring of blood pressure and heart rate 2.
- The standard dose is 60 mg every 4 hours.
- The reduced dose for patients with liver dysfunction is 30 mg every 4 hours.
From the Research
Dose of Nimodipine
- The standard enteral dose of nimodipine recommended after aneurysmal subarachnoid hemorrhage (aSAH) is 60 mg every 4 h 3.
- In children, the mean dose of oral nimodipine was 1 mg/kg every 4 hours 4.
- A study found that a nimodipine cutoff dose of 241.8 mg was associated with better outcomes in patients with SAH 5.
- The dose of nimodipine may need to be adjusted based on individual patient factors, such as blood pressure and age 3, 5.
Administration Routes
- Nimodipine can be administered orally or intravenously 6.
- A sustained-release formulation of nimodipine, EG-1962, can be administered into the subarachnoid space in patients with aSAH 6.
- Intraventricular nimodipine has been shown to be effective in reducing the risk of angiographic vasospasm and hypotension compared to oral nimodipine 6.
Safety and Efficacy
- Nimodipine has been shown to be effective in improving outcomes in patients with aSAH, but its use is associated with a risk of hypotension 4, 3, 5.
- A study found that prophylactic nimodipine did not reduce the incidence of vasospasm in children with SAH, but may improve short-term brain function 7.
- The safety and efficacy of nimodipine in children with SAH need to be further studied 4, 7.