Nimotop Dosage/Direction for Use

Tab: Administration of Nimodipine (Nimotop) tablets is recommended for about 7 days after the end of the 5-14 days infusion therapy with Nimodipine (Nimotop) infusion solution.
In general, the tablets should be swallowed whole with a little liquid, independent of meal time.
Grapefruit juice is to be avoided (see Interactions). The interval between successive doses must not be less than 4 hours.
Dosage regimen: The recommended procedure is administration of Nimodipine (Nimotop) infusion solution for 5 - 14 days, followed by a daily dose of 6 x 2 Nimodipine (Nimotop) tablets (6 x 60 mg nimodipine).
In patients who develop adverse reactions the dose should be reduced as necessary or the treatment discontinued.
Upon co-administration with CYP 3A4 inhibitors or CYP 3A4 inducers a dose-adaptation may be necessary (see Interactions). Prophylactic Use: After the end of the infusion therapy, it is advisable to continue with oral administration of 6 x 60 mg Nimodipine (Nimotop) tablets daily at four-hourly intervals for about further 7 days.
Therapeutic Use: After intravenous application, oral administration of 6 x 60 mg Nimodipine (Nimotop) tablet per day at four-hourly intervals for 7 days is recommended.
Patients with hepatic impairment: Severely disturbed liver function, particularly liver cirrhosis, may result in an increased bioavailability of Nimodipine (Nimotop) due to a decreased first pass capacity and a reduced metabolic clearance. The effects and side-effects, e.g. reduction in blood-pressure, may be more pronounced in these patients. In such cases the dose should be reduced or, if necessary, discontinuation of the treatment should be considered.
Soln for IV infusion: Method of administration: Nimodipine (Nimotop) solution for infusion is administered as a continuous i.v. infusion via a central catheter using an infusion pump. It should be given via a three-way stopcock together with either glucose 5%, sodium chloride 0.9%, lactated Ringer's solution, lactated Ringer's solution with magnesium, dextran 40 solution or HAES (poly(O-2-hydroxyethyl) starch 6% in a ratio of about 1:4 (nimodipine: co-infusion). Also mannitol, human albumin or blood are suitable for co-infusion.
The three-way stopcock should be used to connect the nimodipine polyethylene tube with the co-infusion line and the central catheter.
Nimodipine (Nimotop) solution for infusion must not added to an infusion bag or bottle and must not be mixed with other drugs.
Administration of nimodipine (Nimotop) solution for infusion should be continued during anesthesia, surgery and angiography.
Dosage regimen: Intravenous infusion: At the beginning of treatment 1 mg/h nimodipine (=5 ml nimodipine (Nimotop) solution for infusion/h) for 2 h (about 15 µg/kg body weight/h). If this is well tolerated, and particularly if there is no marked reduction in blood pressure, the dose is increased after 2 h to 2 mg/h nimodipine (= 10 ml nimodipine (Nimotop) solution for infusion/h) (about 30 µg/kg body weight/h).
Patients whose body weight is appreciably below 70 kg or who have labile blood pressure should be started with a dose of 0.5 mg/h nimodipine (= 2.5 ml nimodipine (Nimotop) solution for infusion/h).
Intracisternal Installation: During surgery a freshly prepared dilute solution of nimodipine (1 ml nimodipine (Nimotop) solution for infusion and 19 ml Ringer's solution) warmed up to blood temperature may be instilled intracisternally.
This dilute solution of nimodipine (Nimotop) solution for infusionmust be used immediately after preparation.
Duration of use: Prophylactic Use: Intravenous therapy should be started no later than 4 days after the hemorrhage, and be continued during the period of maximum risk of vasospasm, i.e. up to 10-14 days after the hemorrhage.
If during prophylactic administration of nimodipine (Nimotop) solution for infusion, the source of the hemorrhage is treated surgically, intravenous treatment with nimodipine (Nimotop) solution for infusion should be continued post-operatively for at least 5 days.
After the end of the infusion therapy, it is advisable to continue with oral administration of 6 x 60 mg nimodipine daily at four-hourly intervals for about a further 7 days.
Therapeutic Use: If ischemic neurological disturbances caused by vasospasm after aneurysmal subarachnoid hemorrhage are already present, treatment should be started as early as possible and be continued for at least 5 days up to a maximum of 14 days. Thereafter, oral administration of 6 x 60 mg nimodipine per day at four-hourly intervals for 7 days is recommended.
If during therapeutic administration of nimodipine (Nimotop) solution for infusion, the source of the hemorrhage is treated surgically, intravenous treatment with nimodipine (Nimotop) solution for infusion should be continued post-operatively for at least 5 days.