Section 13 · Monograph
Nimodipine
Reviewed Nov 2026FDA label
Nymalize / genericCalcium channel blocker
- Forms
- Cap: 30mg | Sol: 60mg/20mL
- Dose
- Subarachnoid hemorrhage: 60mg q4h x21 days (30mg q2h if hypotension); oral/enteral ONLY, never IV
- MOA
- Cerebrovascular L-type Ca2+ channel blockade, ↓vasospasm-related ischemia
Black Box Warning
- Do NOT administer nimodipine capsule or solution contents intravenously or by other parenteral routes — cardiovascular collapse, hypotension and death have occurred after IV injection of capsule contents
Indications
- Improve neurologic outcome after aneurysmal subarachnoid hemorrhage (SAH)FDA-labeled
Mechanism of Action
- Dihydropyridine calcium channel blocker with relatively greater effect on cerebral vessels
- Reduces delayed ischemic injury after SAH; mechanism not proven to reverse angiographic vasospasm
Full Dosing
Adult / usual
- 60mg every 4 hours for 21 consecutive days, starting within 96 hours of SAH
- If significant hypotension: 30mg every 2 hours
- If swallowing is impaired, give by oral/NG tube only — the oral solution (Nymalize) is preferred for enteral tubes; never IV
Hepatic
- Hepatic cirrhosis: reduce to 30mg every 4 hours
Contraindications
- Known hypersensitivity to nimodipine
Drug Interactions
- Strong CYP3A4 inhibitors raise levels (hypotension)
- CYP3A4 inducers (carbamazepine, phenytoin, phenobarbital) markedly reduce levels
- Additive hypotension with other antihypertensives
- Grapefruit juice raises levels
Adverse Effects
- Hypotension
- Headache
- Bradycardia and peripheral edema
- GI upset
Monitoring Parameters
- Frequent BP and heart rate, especially early in treatment
- Hepatic function
- Volume status
Pregnancy & Lactation
- Animal teratogenicity; use only if benefit justifies risk
- Present in breast milk; caution