Nimodipine

When ATH:
C08CA06

Characteristic.

A derivative of 1,4-dihydropyridine. Yellow crystalline powder. Practically insoluble in water. Molecular weight 418,5.

Pharmacological action.
Neuroprotective, vazodilatirtee, antiagregatine.

Application.

Ischemic stroke (incl. gipertoničeskom in crisis), Neurological disorders due to cerebral vasospasm, due to subarachnoid hemorrhage, senilynaya dementia.

Contraindications.

Hypersensitivity, severe hypotension, swelling of the brain, increased intracranial pressure, severe liver, cirrhosis of the liver, pregnancy, lactation.

Restrictions apply.

Gipotenziya (mild or moderate), heart failure, cardiogenic shock, myocardial infarction, congestive lung, mild expressed human liver.

Pregnancy and breast-feeding.

Contraindicated in pregnancy.

Category actions result in FDA - C. (The study of reproduction in animals has revealed adverse effects on the fetus, and adequate and well-controlled studies in pregnant women have not held, However, the potential benefits, associated with drugs in pregnant, may justify its use, in spite of the possible risk.)

At the time of treatment should stop breastfeeding.

Side effects.

Cardio-vascular system and blood (hematopoiesis, hemostasis): 1-9% of hypotension; < 1% -tachycardia or bradycardia, heart failure, ECG changes, spasm of peripheral vessels, hypertension, anemia and thrombocytopenia, tendency to thrombosis, phlebitis (at / in the introduction).

From the nervous system and sensory organs: 1-9% - Headache; < 1% -dizziness and depression; possible excitation, aggressiveness, sleep disturbance.

On the part of the musculoskeletal system: 1-9% of muscle spasms.

With the genitourinary system: 1-9% of peripheral edema; < 1% - Giponatriemiya; possible deterioration in kidney function with increasing concentrations of urea or creatinine.

From the digestive tract: 1-9%-dyspepsia, stomach cramps, diarrhea; < 1% - Nausea, vomiting, hepatitis, jaundice, increased levels of LDH, alkaline phosphatase and transaminase.

For the skin: 1-9% is a reddening of the skin, rash; < 1% -itching, Sweating, gemorragii.

Allergic reactions: dermatitis (1–9%).

Other: breathlessness (< 1%).

Cooperation.

Indomethacin, cimetidine, phenobarbital and weaken the effect of sympathomimetic. Enhances the activity of antihypertensive drugs. It increases the likelihood of side effects of cardiac glycosides (and etc. means, causing hypokalemia), xinidina, karʙamazepina, cyclosporine, teofillina, valproatov, lithium salts, beta-blockers. Against the background of potentially nephrotoxic drugs (aminoglikozidy, cephalosporins, furosemid) -possible violation of kidney function. It is not recommended to combine with others. calcium channel blockers (amlodipine, nifedipine, diltiazem, verapamil), methyldopa and / in the introduction of beta-blockers (perhaps a significant reduction in blood pressure, increased negative inotropic action and the development of cardiac decompensation. Infusion solution (It contains 23,7 % alcohol by volume) should not be combined with drugs, incompatible in alcohol.

Overdose.

Symptoms: a significant decrease in blood pressure, tachycardia or bradycardia, nausea, gastrointestinal disorders.

Treatment: cancellation of nimodipine, gastric lavage and administration of activated charcoal (an overdose of oral forms); / in the introduction of dopamine or norepinephrine, simptomaticheskaya therapy.

Dosing and Administration.

Inside, fasting (do not chew the tablets), with a small amount of liquid, / drip, intracisternally.

Acute cerebral ischemia: by 30 mg 4 twice a day for 1 Months (no more).

Prevention and treatment of neurological disorders in ischemic cerebral vasospasm due to subarachnoid hemorrhage: in/in in the form of constant infusions in a dose- 1 mg / h (5 ml / h) during 2 no (about 15 mcg/kg/h), then (good tolerability and absence of hypotension) - 2 mg / h (10 ml / h), that is about 30 mcg/kg/h. Patients weighing less than 70 kg or unstable HELL — in the initial dose of 0,5 mg / h (2,5 ml / h). Intravenous prophylaxis begin no later than 4 day and continued for 10-14 days after hemorrhage. Treatment has evolved neurological disorders should be initiated as early as possible and to hold at least 5 and no more than 14 days. Infusion solution is injected continuously into / through a central catheter using an infusion pump and a three-way stopcock simultaneously with one of the following solutions: 5% glucose solution, 0,9% sodium chloride solution, Ringer, Ringer's solution with magnesium, dextran solution 40 or 6% solution of poly(0-2-Hydroxyethyl)starch ratio 1:4 (nimodipine solution, etc.. solution, respectively). As a concomitant infusion of mannitol can be used, blood or human albumin. For an adequate dilution of nimodipine necessary, administered to over 1 SUT fluid was not less 1000 ml. At the end of the infusion therapy — inside the dose 60 mg 6 times a day at intervals of 4 h for 7 days.

In surgical treatment of subarachnoid hemorrhage may intracisternalnoe introduction 20 ml diluted solution (1 ml for infusions and Nimodipine 19 ml ringer).

Senilynaya dementia: inside, by 30 mg 3 once a day.

Precautions.

In patients with impaired renal function, it may be the progression, requiring discontinuation. Be wary appoint liver diseases, alcoholism, epilepsy in infancy. Should not be used during the drivers of vehicles and people, skills relate to the high concentration of attention. If abnormal liver function (It slows down metabolism) the dose should be reduced in accordance with the severity of hypotension or stop the drug. The sharp drop in blood pressure or the occurrence of severe headaches necessitate discontinuation of therapy. Treatment is not recommended to interrupt during anesthesia, surgery and angiography.

Cautions.

Tablets should not drink grapefruit juice (alters metabolism). We do not recommend the introduction of the solution after a direct hit on him sunlight, adding the solution directly into the infusion bottle or mixing with other drugs. When the scattered daylight or artificial light can be used in injectable form for 10 h without protective measures (ie. no glass syringes and connecting tubes dark). For parenteral administration, it is necessary to use only systems with plastic pipes, tk. the drug is absorbed by polyvinyl chloride.

Cooperation