Oral continuation of prophylaxis and treatment of ischemic neurological deficits caused by cerebral vasospasm following subarachnoid haemorrhage following the rupture of the aneurysm.
Composition:
1 tabl powl. contains 30 mg nimodipine.
Action:
Calcium antagonist. It has a special effect to prevent cerebrovascular narrowing and cerebral ischemia. It can also prevent or eliminate the effect of vasoconstriction inducedin vitro by various substances that display such effects (eg serotonin, prostaglandins and histamine), as well as blood and its breakdown products. Studies conducted in patients with acute cerebral blood flow disorders showed that nimodipine widens cerebral vessels and improves blood flow. Typically, this effect is more marked in damaged and insufficient blood supply in the brain, compared to non-affected areas. After oral administration, nimodipine is absorbed quickly and almost completely. The absolute bioavailability is 5-15%. The maximum concentration in the blood after repeated oral administration of divided doses is reached after 0.6-1.6 hours. It binds to plasma proteins in 97-99%. It is excreted in the form of metabolites in 50% in the urine and in 30% in the bile. T0,5 is 1.1-1.7 h. The terminal half-life is 5-10 h.
Contraindications:
Hypersensitivity to nimodimine or other ingredients of the preparation. Concomitant oral use of nimodipine and antiepileptic drugs (phenobarbital, phenytoin or carbamazepine) is contraindicated. The use of rifampicin significantly reduces the effectiveness of nimodipine administered orally, which is why concomitant administration is contraindicated.
Precautions:
Caution in patients with cerebral edema, increased intracranial pressure or markedly reduced blood pressure (systolic pressure less than 100 mm Hg). Drugs that increase the concentration of nimodipine are: macrolide antibiotics, HIV protease inhibitors, antifungals, antidepressants (nefazodone, fluoxetine), quinupristine / dalfopristin, cimetidine, valproic acid - during co-administration, blood pressure should be monitored and if necessary, the dose should be reduced the drug.
Pregnancy and lactation:
During pregnancy, use only in cases of absolute necessity. It has been shown that nimodipine and its metabolites are excreted in breast milk, it is recommended to stop breast-feeding during drug therapy.
The following dosage is recommended: the initial dose is nimodipine administered intravenously over 5-14 days, and then orally at 360 mg daily (6 times 60 mg nimodipine) for 7 days. In patients who experience side effects, the dose should be reduced or even discontinued. In the case of severe impairment of liver function, nimodipine may increase the bioavailability of nimodipine - depending on the value of blood pressure - the dose should be reduced or, if necessary, discontinued. The tablets should be swallowed whole with a small amount of liquid. The drug can be taken regardless of meals. Between doses should be kept at least 4 hours apart.
(C)
