The following dosing regimen is recommended:
Intravenous infusion. At the beginning of the therapy, 1 mg of nimodipine per hour (5 ml of the Nimotop infusion solution), approximately 15 μg / kg / h, is administered within 2 hours. 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 weighing well below 70 kg or labile blood pressure should be 0.5 mg nimodipine per hour.
Infusion solution Nimotop is used for continuous intravenous infusion through the 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 (Nimotope / other solution). As a concomitant infusion can also be used mannitol, human albumin or blood.
Solution Nimotop can not be added to the infusion vessel or mixed with other drugs.It is recommended to continue the administration of nimodipine during anesthesia, surgery and angiography.
To connect the polyethylene tube, which receives the Nimotop solution, the channel of the concomitant solution and the central catheter, a three-channel stopcock must be used.
Preventive use. 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 x 6 times a day with intervals of 4 hours is recommended.
Therapeutic use. If there are already ischemic neurologic disorders due to vasospasm due to subarachnoid hemorrhage, infusion therapy should be started as early as possible and conducted for at least 5, 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 therapeutic or prophylactic use of the Nimotop solution, surgical treatment for hemorrhage is performed, intravenous therapy with nimodipine should be continued for at least 5 days after surgery. Introduction to the cistern of the brain. During the surgical intervention, a freshly prepared solution of nimodipine (1 ml of Nimotop infusion solution and 19 ml of Ringer's solution), warmed to the average body temperature, can be administered intracistrically. The solution should be used immediately after preparation.
If a patient develops adverse reactions to the drug, either reduce the dose or stop treatment with nimodipine. 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 may be an aggravation of the main and side effects of the drug, 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.
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 diffused daylight or artificial lighting, Nimotop can be used for 10 hours without special protective measures.
Nimodipine, the active substance of the Nimotop infusion solution, is absorbed by polyvinyl chloride, only systems with polyethylene tubes can be used for its parenteral administration.