Administration of Nimodipine and Vitamin C via Nasogastric Tube
Yes, nimodipine tablets can be crushed and administered with crushed vitamin C tablets through a nasogastric or Raouf tube (RT) in patients with subarachnoid hemorrhage who cannot swallow. 1, 2
Evidence for Enteral Nimodipine Administration
Nimodipine (60 mg every 4 hours for 21 days) must be administered enterally via nasogastric or feeding tube when patients cannot swallow, as this is the only Class I, Level of Evidence A recommendation for preventing delayed cerebral ischemia and improving functional outcomes in aneurysmal subarachnoid hemorrhage. 3, 2, 4
The American Heart Association/American Stroke Association guidelines explicitly support enteral administration through nasogastric tubes when oral intake is not possible, and this route has been validated in clinical practice. 1, 2
In clinical studies demonstrating nimodipine's efficacy, the medication was successfully delivered through nasogastric or Dobhoff tubes at the standard 60 mg dose every 4 hours. 5
Practical Administration Technique
Crush the nimodipine tablet and administer it through the feeding tube separately from other medications when possible, flushing the tube before and after administration to ensure complete delivery of the full dose. 1
Vitamin C tablets can be crushed and given through the same tube, but there is no pharmacological interaction between nimodipine and vitamin C that would contraindicate co-administration. 1, 2
Maintain the strict every-4-hour dosing schedule (60 mg six times daily) for the full 21-day course, as disruption of nimodipine therapy is directly associated with increased incidence of delayed cerebral ischemia (ρ=0.431, P<0.001). 1, 2
Critical Management of Hypotension During Tube Administration
Nimodipine-induced hypotension should be managed with vasopressor support (typically norepinephrine) rather than discontinuing or reducing the nimodipine dose, as consistent administration is critical to prevent delayed cerebral ischemia. 1, 2
In patients requiring vasopressor support after aneurysm clipping, the American College of Cardiology recommends continuing nimodipine at the standard 60 mg dose and attempting standard medical interventions to maintain blood pressure before considering dose reduction. 1
Nimodipine can cause significant reductions in mean arterial pressure and brain tissue oxygen tension (PO₂ dropping from 38.4±10.9 mm Hg to 26.9±7.7 mm Hg at 15 minutes post-administration), but these effects are temporary and return to baseline within 2 hours. 5
Common Pitfalls to Avoid
Do not discontinue nimodipine simply because the patient requires tube feeding or vasopressor support—these are manageable situations, not contraindications. 1, 2
Avoid dose reductions when possible, as only 43.6% of eligible patients receive the full recommended dose in clinical practice, and dose reduction is associated with unfavorable clinical outcomes (OR 0.895, p=0.029). 6
Maintain euvolemia (not hypervolemia) while managing blood pressure with vasopressors, as hypervolemia is associated with excess morbidity without outcome benefit. 1, 2, 4
Ensure the feeding tube is properly positioned and patent before each dose, as incomplete delivery compromises the critical 21-day treatment course that begins within 96 hours of hemorrhage onset. 1, 2