|Trade names||Nimotop, Nymalize, others|
|Drug class||Calcium channel blocker (dihydropyridine)|
|Main uses||Vasospasm due to subarachnoid hemorrhage|
|Side effects||Low blood pressure, headache|
|Intravenous, by mouth|
|Onset of action||Rapid|
|Duration of action||4 hrs|
|Typical dose||60 mg q4h|
|Bioavailability||13% (by mouth)|
|Elimination half-life||8–9 hours|
|Excretion||Feces and Urine|
|Chemical and physical data|
|Molar mass||418.446 g·mol−1|
|3D model (JSmol)|
|Melting point||7 °C (45 °F)|
Nimodipine, sold under the brand name Nimotop among others, is a medication used to prevent vasospasm secondary to subarachnoid hemorrhage. It is taken by mouth or by injection into a vein. Onset is rapid with a duration of action of 4 hours.
Common side effects include low blood pressure and headache. Other side effects may include slow heart rate, ileus, and low platelets. Safety in pregnancy is unclear. It is a calcium channel blocker of the dihydropyridine type.
Nimodipine was patented in 1971 and approved for medical use in Germany in 1985. It was approved in the United States in 1988. In the United Kingdom 100 tablets of 30 mg costs the NHS about £40. This amount in the United States costs about 170 USD.
Because it has some selectivity for cerebral vasculature, nimodipine's main use is in the prevention of cerebral vasospasm and resultant ischemia, a complication of subarachnoid hemorrhage (a form of cerebral bleed), specifically from ruptured intracranial berry aneurysms irrespective of the patient's post-ictus neurological condition. Its administration begins within 4 days of a subarachnoid hemorrhage and is continued for three weeks. If blood pressure drops by over 5%, dosage is adjusted. There is still controversy regarding the use of intravenous nimodipine on a routine basis.
Nimodipine is not regularly used to treat head injury. Several investigations have been performed evaluating its use for traumatic subarachnoid hemorrhage; a systematic review of 4 trials did not suggest any significant benefit to the patients that receive nimodipine therapy. There was one report case of nimodipine being successfully used for treatment of ultradian bipolar cycling after brain injury and, later, amygdalohippocampectomy.
The regular dosage is 60 mg tablets every four hours for 3 weeks. If the patient is unable to take tablets orally, it was previously given via intravenous infusion at a rate of 1–2 mg/hour (lower dosage if the body weight is <70 kg or blood pressure is too low), but since the withdrawal of the IV preparation, administration by nasogastric tube is an alternative.
Nimodipine is associated with low blood pressure, flushing and sweating, edema, nausea and other gastrointestinal problems, most of which are known characteristics of calcium channel blockers. It is contraindicated in unstable angina or an episode of myocardial infarction more recently than one month.
While nimodipine was occasionally administered intravenously in the past, the FDA released an alert in January 2006, warning that it had received reports of the approved oral preparation being used intravenously, leading to severe complications; this was despite warnings on the box that this should not be done.
The FDA has classified the side effects into groups based on dosages levels at q4h. For the high dosage group (90 mg) less than 1% of the group experienced adverse conditions including itching, gastrointestinal hemorrhage, thrombocytopenia, neurological deterioration, vomiting, diaphoresis, congestive heart failure, hyponatremia, decreasing platelet count, disseminated intravascular coagulation, deep vein thrombosis.
After oral administration, it reaches peak plasma concentrations within one and a half hours. Patients taking enzyme-inducing anticonvulsants have lower plasma concentrations, while patients taking sodium valproate were markedly higher.
Nimodipine is metabolized in the first pass metabolism. The dihydropyridine ring of the nimodipine is dehydrogenated in the hepatic cells of the liver, a process governed by cytochrome P450 isoform 3A (CYP3A). This can be completely inhibited however, by troleandomycin (an antibiotic) or ketoconazole (an antifungal drug).
Studies in non-human mammals using radioactive labeling have found that 40–50% of the dose is excreted via urine. The residue level in the body was never more than 1.5% in monkeys.
Mechanism of action
Nimodipine binds specifically to L-type voltage-gated calcium channels. There are numerous theories about its mechanism in preventing vasospasm, but none are conclusive.
The key acetoacetate (2) for the synthesis of nimodipine (5) is obtained by alkylation of sodium acetoacetate with 2-methoxyethyl chloride, Aldol condensation of meta-nitrobenzene (1) and the subsequent reaction of the intermediate with enamine (4) gives nimodipine.
|Enantiomers of nimodipine|
CAS number: 77940-92-2
CAS number: 77940-93-3
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Priority date: 1971-04-10 (...) Date issued: 1974-07-03CS1 maint: location (link)
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