Nimodipine

About Nimodipine

Nimodipine is labeled for adults with subarachnoid hemorrhage from a ruptured intracranial berry aneurysm, whatever their neurological condition after the bleed, to reduce how often and how badly parts of the brain are damaged by poor blood flow. Treatment starts as soon as possible within 96 hours of the bleed: 60 mg (two 30 mg capsules) every 4 hours for 21 consecutive days, preferably at least one hour before or two hours after a meal. People with cirrhosis or severely impaired liver function take 30 mg every 4 hours with close checks of blood pressure and pulse. Safety and effectiveness in children have not been established.

The capsule’s boxed warning says deaths and serious, life-threatening events have occurred when capsule contents were injected, so the capsules are never given into a vein or by any other parenteral route. If a patient cannot swallow, the label describes piercing the capsule, drawing the liquid into an oral syringe that cannot take a needle and is marked not for IV use, giving it through a nasogastric tube and flushing with 30 mL of normal saline. A fall in blood pressure is the most frequent side effect, so blood pressure and heart rate are watched; headache, nausea, a slow heartbeat and swelling also occur. The capsule label rules out strong CYP3A4 inhibitors, such as clarithromycin, ketoconazole, itraconazole, voriconazole, nefazodone and some HIV protease inhibitors, because blood pressure can drop sharply.

The oral solution comes in two strengths that must not be confused: at 6 mg per mL (Nymalize) a 60 mg dose is 10 mL, while at 3 mg per mL (a generic) the same dose is 20 mL. Strong CYP3A4 inducers such as rifampin, carbamazepine, phenytoin, phenobarbital and St. John’s wort can make it much less effective and are generally avoided, and grapefruit juice raises its levels, with an extra lowering of blood pressure that can last at least four days after the last glass. If a hospital stay ends before the 21 days are up, the remaining doses are filled by a pharmacy.

Taking Nimodipine

How to take it

Every 4 hours around the clock for 21 days, at least one hour before or two hours after a meal. Swallow capsules whole with a little liquid, and measure a solution with an oral syringe, not a kitchen spoon. Capsule contents and solution are never injected.

If you miss a dose

Take it as soon as you can, unless it is almost time for the next dose; then skip the missed dose. Do not take two doses at once.

Storage

At room temperature, protected from light. Keep capsules in their original package until use and do not let them freeze; do not refrigerate the solutions.

Interactions to know about

Strong CYP3A4 inhibitors such as clarithromycin, ketoconazole and some HIV protease inhibitors can cause a dangerous drop in blood pressure; diltiazem, verapamil, fluconazole and erythromycin can raise its levels; rifampin, carbamazepine, phenytoin and St. John’s wort can make it much less effective. Avoid grapefruit and grapefruit juice. Other blood pressure medicines add to its effect.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Nimodipine differs from pharmacy to pharmacy

A full course is a lot of medicine: two capsules six times a day for up to 21 days, supplied in unit-dose packs, so the quantity, not just the dispensing fee, shapes the quote. A pharmacy that does not stock it may need to order it, which matters when a dose is due every four hours.

Nymalize is priced as a brand, and its prefilled syringes and bottle are priced differently. A 6 mg per mL generic is rated equivalent to it, while the 3 mg per mL generic is a different strength that a pharmacy cannot swap in on its own.

Ways to pay less for Nimodipine without insurance

• Before leaving the hospital, ask the team to send the prescription early and to name the form and strength, so the pharmacy can order it in time.
• Ask for exactly the number of doses left in the 21-day course, so you do not pay for medicine you will not use.
• For capsules, ask for the generic and compare more than one pharmacy.
• If a solution is prescribed, ask whether a generic rated equivalent to Nymalize is stocked and whether the prescriber would write for the 3 mg per mL generic; for Nymalize, ask the maker whether a savings program applies to someone paying cash.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Nimodipine

1. 1.How many doses are left in my 21-day course, and do you have enough in stock?
2. 2.How do I time doses every 4 hours around meals?
3. 3.Is my solution 3 mg or 6 mg per mL, and how many mL is my dose?
4. 4.Which of my medicines, supplements or foods interact with it?

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