Nimodipine is a second generation calcium channel blocker used in the treatment of cerebral vasospasm after subarachnoid hemorrhage. Nimodipine is not widely used and has not been implicated in causing clinically apparent acute liver injury.
Nimodipine (nye moe' di preen) belongs to the dihydropyridine class of calcium channel blockers (similar to amlopidine and felodipine) and is used to treat cerebral vasospasm after subarachnoid hemorrhage. Like other calcium channel blockers, nimodipine acts by inhibition of the influx of calcium ions into smooth muscle cells during depolarization which results in vasodilation. Nimodipine has high lipid solubility and was developed specifically to treat cerebral vasospasm. Clinical trials have suggested that nimodipine reduces infarct size and complications after subarachnoid hemorrhage. Nimodipine was approved for use in the United States in 1988 but is not widely used, largely because of its restricted indications. Nimodipine is available in generic forms and under the commercial name Nimotop as capsules of 30 mg. The recommend dose in adults is 60 mg every 4 hours for 21 days starting as soon as possible or within 96 hours of the diagnosis of subarachnoid hemorrhage. Like most calcium channel blockers, nimodipine is generally well tolerated and side effects are largely due to its vasodilating activities and can include headache, dizziness, flushing, fatigue, nausea, diarrhea, peripheral edema, palpitations and rash.
Hepatotoxicity, Outcome and Management
Nimodipine has been associated with only rare reports of serum enzyme elevations during therapy. These elevations are usually mild, transient and not associated with symptoms or need for dose modification. Nimodipine is not widely used and has not been linked to instances of clinically apparent liver injury. Thus, hepatotoxicity from nimodipine must be rare, if it occurs at all.
Likelihood score: E (Unlikely cause of clinically apparent liver injury).
The reason why some calcium channel blockers cause liver injury (verapamil, diltiazem, amlodipine) while others (such as nimodipine) do not is not known. Because liver injury from calcium channel blockers is rare, those that are uncommonly used may just not have had enough exposures to manifest idiosyncratic cases of liver injury. Nimodipine is metabolized in the liver largely via CYP 3A4 and is susceptible to drug-drug interactions with agents that induce or inhibit CYP 3A4.
REPRESENTATIVE TRADE NAMES
Nimodipine – Generic, Nimotop®
Product labeling at DailyMed, National Library of Medicine, NIH
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References updated: 11 January 2017
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