nimodipina

Nimodipina, the Spanish name for nimodipine, is a calcium channel blocker used primarily in the management of cerebral vasospasm after aneurysmal subarachnoid hemorrhage. It is formulated for oral administration and is not intended for intravenous use due to the risk of severe hypotension.

Pharmacology and mechanism

Nimodipine is a dihydropyridine calcium channel blocker with high lipophilicity, which allows preferential delivery to cerebral vessels. By inhibiting L-type calcium channels in vascular smooth muscle, nimodipine promotes cerebral vasodilation and helps reduce delayed cerebral ischemia associated with vasospasm after subarachnoid hemorrhage. Its effects are more pronounced in cerebral arteries than in systemic vessels, contributing to a more targeted cerebrovascular action.

Indications and administration

Nimodipina is indicated for the prevention of poor outcome caused by cerebral vasospasm following aneurysmal subarachnoid hemorrhage. The usual dosing is 60 mg every 4 hours for 21 days, started within a few days after hemorrhage as part of standard care. It is taken orally with water, and may be used with or without food as prescribed. If oral administration is not possible, alternative strategies should be discussed with a clinician.

Contraindications and precautions

Contraindications include significant hypotension and hypersensitivity to nimodipine. Because nimodipina can cause or worsen low blood pressure, blood pressure should be monitored regularly, especially when used with other antihypertensives. Caution is advised in hepatic impairment due to reduced clearance and potential drug accumulation.

Adverse effects and interactions

Common adverse effects include headache, dizziness, flushing, nausea, and hypotension. Edema and bradycardia may occur. Nimodipina interacts with strong CYP3A4 inhibitors and inducers, grapefruit juice, and other drugs affecting blood pressure. Dose adjustments or avoidance may be needed when such drugs are used.

See also: nimodipine in clinical guidelines, brand names such as Nimotop.