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Calcium Channel Blocker (neuroprotective) Pregnancy: UK SPC (written for the infusion product) - 'There are no adequate and well controlled studies in pregnant women. No reproductive toxicology studies following parenteral administration are available. Reproductive toxicology studies in animals after oral administration showed no teratogenic effect, although studies in animals have shown reproductive toxicity. If Nimotop solution is to be administered during pregnancy, the benefits and the potential risks must, therefore, be carefully weighed according to the severity of the clinical picture.' Breast-feeding - 'Nimodipine and its metabolites have been shown to be present in human milk at concentrations of the same order of magnitude as corresponding maternal plasma concentrations. Nursing mothers should be advised not to breast-feed when taking this drug.' No pregnancy section was retrieved from the US oral label.

Nimodipine

Brand names: Nimotop

Nimodipine is a calcium-channel blocker used specifically to prevent and treat delayed cerebral ischaemia (vasospasm) after aneurysmal subarachnoid haemorrhage.

Adult dose

Dose: 60 mg (two 30 mg capsules) every 4 hours for 21 consecutive days
Route: Oral - 30 mg soft gelatin capsules, swallowed whole; if the capsule cannot be swallowed the contents may be given via naso-gastric tube or PEG. NEVER intravenously or by any other parenteral route.
Frequency: Every 4 hours, for 21 consecutive days
SCOPE: this covers the page's PRIMARY route (oral) for subarachnoid haemorrhage only, and comes from US labelling. The intravenous infusion regimen also listed on this page is NOT covered by the dose above - it belongs to a different product ('Nimotop 0.02% Solution for Infusion', eMC product 1366) and must be taken from that infusion SPC, which states 'Nimotop solution and tablets should not be used concomitantly', 'Nimotop solution should not be administered for longer than 14 days', and 'In the event of Nimotop tablets and Nimotop solution being administered sequentially the total duration of treatment should not exceed 21 days.' ROUTE WARNING (verbatim, US oral label): 'DO NOT ADMINISTER NIMODIPINE CAPSULES INTRAVENOUSLY OR BY OTHER PARENTERAL ROUTES ... If nimodipine is inadvertently administered intravenously, clinically significant hypotension may require cardiovascular support with pressor agents.' DOSE (verbatim): 'Nimodipine is given orally in the form of soft gelatin 30 mg capsules for subarachnoid hemorrhage. The recommended oral dose is 60 mg (two 30 mg capsules) every 4 hours for 21 consecutive days.' TIMING: 'Oral nimodipine therapy should commence as soon as possible within 96 hours of the onset of subarachnoid hemorrhage.' ADMINISTRATION: 'In general, the capsules should be swallowed whole with a little liquid, preferably not less than one hour before or two hours after meals. Grapefruit juice is to be avoided.' If the capsule cannot be swallowed, 'a hole should be made in both ends of the capsule with an 18 gauge needle, and the contents of the capsule extracted into a syringe ... the liquid should always be transferred to a syringe that cannot accept a needle and that is designed for administration orally or via a naso-gastric tube or PEG ... it is recommended that the syringe used for administration be labeled "Not for IV Use". The contents should then be emptied into the patient's in situ naso-gastric tube and washed down the tube with 30 mL of normal saline (0.9%).' NO MAXIMUM DAILY DOSE is stated in either fetched label - no total daily ceiling appears anywhere in the bundle, so maxDose is left empty (the 90 mg and 120 mg every-4-hours figures in the US adverse-reaction table are study dose groups, not a permitted ceiling). CYP3A4: 'Strong inhibitors of CYP3A4 should not be administered concomitantly with nimodipine ... Strong inducers of CYP3A4 should generally not be administered with nimodipine. Patients on moderate and weak inducers of CYP3A4 should be closely monitored for lack of effectiveness, and a nimodipine dose increase may be required. Patients on moderate and weak CYP3A4 inhibitors may require a nimodipine dose reduction in case of hypotension.' TRAUMATIC SUBARACHNOID HAEMORRHAGE (UK SPC): 'Not recommended as a positive benefit to risk ratio has not been established.' PAEDIATRIC (UK SPC): 'The safety and efficacy of Nimotop in patients under 18 years of age have not been established' - no paediatric dose is given in either label; verify any paediatric use against a children's formulary.

Dose adjustments

Renal

No renal dose adjustment is stated in either fetched label. The UK SPC advises monitoring rather than a dose change: 'Patients with known renal disease and/or receiving nephrotoxic drugs should have renal function monitored closely during intravenous treatment with Nimotop solution.'

Hepatic

US oral label - 'Severely disturbed liver function, particularly liver cirrhosis, may result in an increased bioavailability of nimodipine due to a decreased first pass capacity and a reduced metabolic clearance. The reduction in blood pressure and other adverse effects may be more pronounced in these patients. 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.' UK SPC (infusion product) adds: 'Decreased drug clearance may occur in cirrhotic patients receiving Nimotop and, therefore, close monitoring of blood pressure is recommended in these patients.'

Dose independently re-sourced from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — clinician-reviewed. Always confirm against the product SmPC and your local formulary before prescribing.

US labelling (FDA)

Reference — US labelling, may differ from UK

DOSAGE AND ADMINISTRATION DO NOT ADMINISTER NIMODIPINE CAPSULES INTRAVENOUSLY OR BY OTHER PARENTERAL ROUTES (see WARNINGS ). If nimodipine is inadvertently administered intravenously, clinically significant hypotension may require cardiovascular support with pressor agents. Specific treatments for calcium channel blocker overdose should also be given promptly. Nimodipine is given orally in the form of soft gelatin 30 mg capsules for subarachnoid hemorrhage. The recommended oral dose is 60 mg (two 30 mg capsules) every 4 hours for 21 consecutive days. In general, the capsules should be swallowed whole with a little liquid, preferably not less than one hour before or two hours after meals. …

Source: US FDA prescribing information (openFDA / DailyMed), label dated 2024-08-16. Accessed 2026-06-12. US dosing and indications can differ from UK practice — use UK sources for prescribing decisions.

Contraindications

  • Concomitant strong CYP3A4 inhibitors - 'The concomitant use of nimodipine with strong inhibitors of CYP3A4 such as some macrolide antibiotics (e.g., clarithromycin, telithromycin), some anti-HIV protease inhibitors (e.g., delaviridine, indinavir, nelfinavir, ritonavir, saquinavir), some azole antimycotics (e.g., ketoconazole, itraconazole, voriconazole) and some antidepressants (e.g., nefazadone) is contraindicated because of a risk of significant hypotension.' (US oral label)
  • Intravenous or other parenteral administration of the oral capsules - 'DO NOT ADMINISTER NIMODIPINE CAPSULES INTRAVENOUSLY OR BY OTHER PARENTERAL ROUTES.' (US oral label)
  • Hypersensitivity to the active substance or to any of the excipients (UK SPC, infusion product)
  • During or within one month of a myocardial infarction or an episode of unstable angina - 'Nimodipine should not be administered to patients during or within one month of a myocardial infarction or an episode of unstable angina.' (UK SPC, infusion product)
  • Traumatic subarachnoid haemorrhage is not recommended - 'a positive benefit to risk ratio has not been established and the specific patient groups that might benefit cannot be identified for this indication.' (UK SPC, infusion product)

Side effects

  • Decreased blood pressure - the most frequently reported adverse experience, in 4.4% of the 823 patients with subarachnoid haemorrhage given nimodipine; 19 of 494 patients (3.8%) in the 60 mg every-4-hours group (US oral label)
  • Headache - 6 of 494 (1.2%) at 60 mg every 4 hours (US oral label)
  • Nausea - 6 of 494 (1.2%) at 60 mg every 4 hours (US oral label)
  • Bradycardia - 5 of 494 (1.0%) at 60 mg every 4 hours (US oral label)
  • Rash - 3 of 494 (0.6%) at 60 mg every 4 hours (US oral label)
  • Abnormal liver function test - 2 of 494 (0.4%) at 60 mg every 4 hours (US oral label)
  • Oedema - 2 of 494 (0.4%) at 60 mg every 4 hours (US oral label)
  • Muscle pain/cramp - 1 of 494 (0.2%) at 60 mg every 4 hours (US oral label)
  • Reported in the US table only at dose groups OTHER than 60 mg every 4 hours: diarrhoea, gastrointestinal symptoms, dyspnoea, EKG abnormalities, tachycardia, acne and depression
  • UK SPC (aneurysmal subarachnoid haemorrhage trials of the infusion product), all uncommon, rare or frequency not known: thrombocytopenia, allergic reaction, rash, headache, tachycardia, bradycardia, hypotension, vasodilatation, nausea, ileus, transient increase in liver enzymes, injection and infusion site reactions including infusion site (thrombo-)phlebitis, and hypoxia
  • SOURCE LIMITATION: the US ADVERSE REACTIONS text ends at the source-fetch limit while listing reactions with an incidence below 1% in the 60 mg every-4-hours group ('hepatitis; ...'), so that sub-1% list is incomplete.

Monitoring

  • Blood pressure - decreased blood pressure was the most frequently reported adverse experience (4.4%); the UK SPC adds that nimodipine 'must be used with caution in hypotensive patients (systolic blood pressure lower than 100 mm Hg)'
  • Blood pressure and heart rate closely, whenever the dose is reduced for severely disturbed liver function - 'Dosage should be reduced to one 30 mg capsule every 4 hours with close monitoring of blood pressure and heart rate.' (US oral label)
  • Blood pressure in cirrhotic patients - 'Decreased drug clearance may occur in cirrhotic patients receiving Nimotop and, therefore, close monitoring of blood pressure is recommended in these patients.' (UK SPC)
  • Blood pressure when a CYP3A4 inhibitor is co-administered - 'Upon co-administration with these drugs, the blood pressure should be monitored and, if necessary, a reduction in the nimodipine dose should be considered.' (UK SPC)
  • Renal function - 'Patients with known renal disease and/or receiving nephrotoxic drugs should have renal function monitored closely during intravenous treatment with Nimotop solution.' (UK SPC)
  • Close monitoring where cerebral oedema or severely raised intracranial pressure is present, or where brain-tissue water content is elevated (UK SPC)
  • Effectiveness, in patients on moderate or weak CYP3A4 inducers - they 'should be closely monitored for lack of effectiveness, and a nimodipine dose increase may be required.' (US oral label)

Clinical monograph

How it works

A dihydropyridine with relative cerebral selectivity, it reduces vasospasm in the cerebral circulation.

Prescribing in practice

  • Give it orally (continuously, typically every 4 hours) wherever possible; it is not interchangeable with other calcium-blocker indications.
  • Hypotension can occur.
  • The intravenous formulation must be given only by specialists as a controlled infusion (never a bolus), and it interacts with PVC infusion equipment.

Monitoring

Monitor blood pressure and neurological status (a critical-care/neurosurgical setting).

Counselling the patient

  • It is given to protect the brain after the bleed; staff will monitor your blood pressure closely.

Evidence & guidelines

Improves neurological outcome after aneurysmal subarachnoid haemorrhage (standard neurosurgical/critical-care practice).

Reference: NICE NG228 Subarachnoid Haemorrhage; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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