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(NYE-moE-dih-peen)
Nimotop,  Nimotop I.V.
Class: Calcium channel blocker

 Action Inhibits movement of calcium ions across cell membrane in systemic and coronary vascular smooth muscle and myocardium. Has greater effect on cerebral arteries than on other arteries.

 Indications Improvement of neurologic deficits caused by vasospasm after subarachnoid hemorrhage from ruptured congenital intracranial aneurysms. unlabeled use(s): Treatment of common and classic migraine and chronic cluster headache.

 Contraindications Standard considerations.

 Route/Dosage

Subarachnoid Hemorrhage

ADULTS: PO/Nasogastric 60 mg q 4 hr for 21 consecutive days. Initiate therapy within 96 hr of subarachnoid hemorrhage.

Headaches

ADULTS: PO 30 mg tid.

 Interactions

Beta-blockers: May cause increased adverse effects because of myocardial contractility or atrioventricular (AV) conduction depression. Fentanyl: May cause severe hypotension or increased fluid requirements. Other hypertensive agents: May have additive effects.

 Lab Test Interferences None well documented.

 Adverse Reactions

CV: Peripheral edema; hypotension; hypertension; bradycardia; CHF; tachycardia; abnormal ECG. CNS: Rebound vasospasm; headache; dizziness; psychiatric disturbances. DERM: Rash; acne. GI: Nausea; diarrhea; abdominal discomfort; cramps; dyspepsia; GI hemorrhage. HEPA: Hepatitis; hepatotoxicity; elevated LDH, alkaline phosphatase and ALT levels. HEMA: Disseminated intravascular coagulation; thrombocytopenia; deep vein thrombosis. RESP: Shortness of breath; wheezing. OTHER: Flushing; muscle cramps, pain, and inflammation.

 Precautions

Pregnancy: Category C. Lactation: Undetermined. Children: Safety and efficacy not established. Antiplatelet effects: Calcium channel blockers may inhibit platelet function. Hepatic impairment: Use drug with caution in patients with impaired hepatic function or reduced hepatic blood flow.

PATIENT CARE CONSIDERATIONS

 Administration/Storage

  • If capsule cannot be swallowed, make hole in both ends of capsule with 18-gauge needle and extract contents into syringe. Empty contents into patient’s nasogastric tube and wash down tube with 30 mL of normal saline solution.
  • Patient may require decreased dose if liver dysfunction is present.
  • Administer drug around the clock.
  • Do not abruptly withdraw drug; dosage must be tapered.
  • Store at room temperature in original foil packaging.

 Assessment/Interventions

  • Obtain patient history, including drug history and any known allergies. Note liver dysfunction, respiratory difficulties, unusual bruising or bleeding, GI problems, rashes, acne, joint pain, deep vein thrombosis or muscle cramping.
  • Obtain baseline vital signs.
  • Assess patient’s neurological status and document any deficits.
  • If patient has history of liver, renal, or cardiac dysfunction, monitor closely for change from baseline.
  • If patient is hypotensive or bradycardic or has respiratory difficulties, notify physician.
  • If nausea, vomiting, diarrhea, abdominal cramping, or increased bruising or bleeding occurs, notify physician.
OVERDOSAGE: SIGNS & SYMPTOMS
  Nausea, weakness, dizziness, drowsiness, confusion, slurred speech, marked and prolonged hypotension, bradycardia, decreased cardiac output, junctional rhythms, second-or third-degree AV block, palpitations, flushing, nervousness, loss of consciousness, vomiting, generalized edema

 Patient/Family Education

  • Explain that medication needs to be taken around the clock for 21 days.
  • Instruct patient to report the following symptoms to physician: Shortness of breath, nausea, abdominal cramping, diarrhea, unusual bruising or bleeding, palpitations, dizziness, faint feeling, or swelling of hands or feet.

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