Intravenous infusion
The following dosing regimen is recommended.
At the beginning of therapy for 2 hours, 1 mg nimodipine per hour (5 ml infusion solution of the drug Nimodipine-native), about 15 μg / kg / hr. With good tolerability (especially in the absence of a marked decrease in blood pressure), after 2 hours the dose is increased to 2 mg of nimodipine per hour (approximately 30 μg / kg / h). The initial dose for patients with a body weight of well below 70 kg or labile blood pressure should be 0.5 mg nimodipine per hour.
Application for the prevention of ischemic neurological disorders
Intramuscular therapy with nimodipine should begin no later than 4 days after hemorrhage, and continue throughout the period of maximum risk of vasospasm development, that is, up to 10-14 days after subarachnoid hemorrhage. After the end of the infusion therapy for the next 7 days, oral intake of the tablet form of nimodipine at a dose of 60 mg 6 times a day (every 4 hours) is recommended.
Application for the treatment of ischemic neurological disorders
If there are already ischemic neurological disorders,caused by vasospasm due to subarachnoid hemorrhage, infusion therapy should be started as early as possible and conducted for at least 5 days, but not more than 14 days. After the end of the infusion therapy for the next 7 days, oral intake of the tablet form of nimodipine at a dose of 60 mg 6 times a day (every 4 hours) is recommended.
If during the use of the drug Nimodipine-native surgical treatment of hemorrhage, intravenous therapy with nimodipine should be continued for at least 5 days after surgery.
Introduction to brain cisterns
During the surgical intervention, freshly prepared nimodipine solution (1 ml infusion solution of the drug Nimodipine-native and 19 ml Ringer's solution), warmed to the average body temperature, can be administered intracisternally.
The solution should be used immediately after preparation.
Use in special patient groups
If the patient develops unwanted reactions to the drug Nimodipine-native, should either reduce the dose, or stop therapy with nimodipine.
Patients with hepatic impairment
In severe liver function disorders, especially with liver cirrhosis, the bioavailability of nimodipine can be increased due to a decrease in the intensity of primary metabolism and a slowing of metabolic inactivation. A consequence of this can be an aggravation of both the main and side effects of nimodipine, in particular, its hypotensive effect. In such cases, the dose of the drug should be reduced, based on the degree of reduction in blood pressure; If necessary, treatment should be interrupted.
Patients with impaired renal function
In patients with renal failure, treatment should be carefully monitored. If there is a violation of kidney function, taking the drug Nimodipine-native should be discontinued.
Method of application of the infusion solution, compatible solutions and equipment
Infusion solution Nimodipine-native is used for continuous intravenous administration through a central catheter using an infusion pump and a three-channel stopcock simultaneously with one of the following solutions:
5 % dextrose, 0,9 % sodium chloride, Ringer's solution, Ringer's solution with magnesium, a solution of dextran 40 or 6% hydroxyethyl starch in a ratio of approximately 1: 4 (Nimodipine-native : another solution).As a concomitant infusion solution can also be used mannitol, human albumin or blood. Solution Nimodipine-native Do not add to the infusion vessel or mix with other medications. It is recommended to continue the administration of nimodipine during anesthesia, surgery and angiography.
For the connection of a polyethylene tube, through which a solution Nimodipine-native, channel of admission of the concomitant solution and the central catheter, it is necessary to use a three-channel stopcock.
Nimodipine is sensitive to light, so you should avoid direct exposure to sunlight: use glass syringes and connecting tubes black, brown, yellow or red; In addition, it is advisable to wrap the infusion pump and tubes with opaque paper. With diffuse daylight or artificial light, the solution Nimodipine-native can be used for 10 hours without special protective measures. Nimodipine, the active substance of the infusion solution Nimodipine-native, absorbed by polyvinyl chloride, for its parenteral administration, only systems with polyethylene tubes can be used.