Calcium Channel Blocker (neuroprotective) Pregnancy: Avoid — limited safety data.

Nimodipine

Brand names: Nimotop

Adult dose

Dose: 60 mg every 4 hours for 21 days

Route: Oral (preferred); IV infusion via central line if oral not possible

Frequency: Every 4 hours (6 times daily)

Max: 360 mg/day

For prevention of cerebral vasospasm after subarachnoid haemorrhage. IV dose: 1 mg/hour initially (0.5 mg/hr if hypotensive), increasing to 2 mg/hour. Must be given into large peripheral or central vein with polyethylene tubing (nimodipine degrades PVC).

Paediatric dose

Route: Oral

Frequency: Not established in children

Max: N/A

Not licensed for children. Specialist guidance required.

Dose adjustments

Renal

No dose adjustment required.

Hepatic

Reduce dose in severe hepatic impairment; increased bioavailability.

Clinical pearls

Must use polyethylene or glass tubing — nimodipine absorbs into PVC
Protect IV solution from light
Oral route preferred; tablets may be swallowed whole or crushed into liquid
Continue for full 21 days even if vasospasm resolved

Contraindications

Severe hypotension
Concomitant IV beta-blockers
Hepatic failure (relative)

Side effects

Hypotension
Flushing
Headache
Nausea
Peripheral oedema
Bradycardia

Interactions

Antihypertensives — additive hypotension
CYP3A4 inhibitors (e.g., clarithromycin) — increased nimodipine levels
CYP3A4 inducers (e.g., rifampicin) — reduced nimodipine levels
IV beta-blockers — contraindicated (severe cardiac depression)

Monitoring

Blood pressure (especially with IV)
Liver function tests
Neurological status

Reference: BNFc; BNF; NICE NG228 Subarachnoid Haemorrhage. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways