Neuromuscular blockers: (Moderate) Concomitant use of neuromuscular blockers and calcium-channel blockers may prolong neuromuscular blockade. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. document.write(new Date().getFullYear()) PDR, LLC. Fostamatinib: (Moderate) Monitor blood pressure and watch for an increase in nimodipine-related adverse reactions if coadministration with fostamatinib is necessary; consider reducing the dose of nimodipine if needed. Apomorphine: (Moderate) Use of calcium-channel blockers and apomorphine together can increase the hypotensive effects of apomorphine. Ombitasvir; Paritaprevir; Ritonavir: (Moderate) Anti-retroviral protease inhibitors are CYP3A4 inhibitors and may decrease the hepatic metabolism of nimodipine, leading to increased plasma concentrations of nimodipine. Dapoxetine (Priligy TM, Johnson and Johnson, Raritan, NJ) is the first and only product licensed for the treatment of premature ejaculation (PE) in men aged 18-64 years.At present, dapoxetine is licensed in ten countries, including several countries in Europe, and Mexico, South Korea, and New Zealand.1,2 PE is the most common sexual dysfunction in men, with a . Verteporfin: (Moderate) Use caution if coadministration of verteporfin with calcium channel blockers is necessary due to the risk of increased photosensitivity. Bendroflumethiazide; Nadolol: (Moderate) Nimodipine, a selective calcium-channel blocker, can enhance the antihypertensive effects of beta-blockers. Echinacea: (Moderate) Moderate and inducers of CYP3A4 may reduce the efficacy of nimodipine, although the magnitude of decrease in nimodipine plasma concentrations is not known. ER -, Your free 1 year of online access expired. Monitor therapeutic response and for adverse effects, such as hypotension. Dosage adjustments of the antihypertensive medication may be required. Well-controlled hypertensive patients receiving decongestant sympathomimetics at recommended doses do not appear to be at high risk for significant elevations in blood pressure; however, increased blood pressure (especially systolic hypertension) has been reported in some patients. Nefazodone: (Moderate) Nefazodone is a CYP3A4 inhibitor which theoretically may decrease hepatic metabolism of nimodipine, a CYP3A4 substrate. Although often used together, concurrent use of calcium-channel blockers and beta-blockers may result in additive hypotensive, negative inotropic, and/or bradycardic effects in some patients. Hydrocodone; Ibuprofen: (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Adagrasib: (Major) Avoid coadministration of nimodipine with adagrasib due to the risk of significant hypotension. If coadministration is necessary, monitor patients closely and increase the nimodipine dosage as appropriate. Monitor therapeutic response and for adverse effects, such as hypotension. The decrease in intracellular calcium inhibits the contractile processes of smooth muscle cells, causing dilation of the arteries and increased oxygen delivery to the area being supplied.While verapamil and diltiazem exert balanced effects on calcium channels in the SA node, AV node, and vasculature, nimodipine and other members of the dihydropyridine group predominantly act on the vasculature, making these agents potent peripheral vasodilators. Amlodipine is the first line of choice among other anti-hypertensive. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. (Moderate) Anti-retroviral protease inhibitors are CYP3A4 inhibitors and may decrease the hepatic metabolism of nimodipine, leading to increased plasma concentrations of nimodipine. Pindolol: (Moderate) Nimodipine, a selective calcium-channel blocker, can enhance the antihypertensive effects of beta-blockers. Concurrent use may increase nimodipine exposure. is a Professor at the Departments of Neurological Surgery and Neurology, and Chief of the Division of Neurocritical Care, University of Texas Southwestern Medical Center, Dallas, TX. Dorzolamide; Timolol: (Moderate) Nimodipine, a selective calcium-channel blocker, can enhance the antihypertensive effects of beta-blockers. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. This additive effect can be desirable, but the patient should be monitored carefully and the dosage should be adjusted based on clinical response. Efavirenz; Emtricitabine; Tenofovir Disoproxil Fumarate: (Moderate) Use caution and careful monitoring when coadministering efavirenz with calcium-channel blockers; efavirenz induces CYP3A4, potentially altering serum concentrations of drugs metabolized by this enzyme such as some calcium-channel blockers. Concurrent use may increase nimodipine exposure. Tipranavir: (Moderate) Anti-retroviral protease inhibitors are CYP3A4 inhibitors and may decrease the hepatic metabolism of nimodipine, leading to increased plasma concentrations of nimodipine. 1 It is dosed at 60 mg every 4 hours for a total of 21 days post ictus. Journal of Neuroscience Nursing54(1):19-22, February 2022. This activity outlines the indications, mechanism of action, methods of administration, important adverse effects, contraindications . Nimodipine is a CYP3A4 substrate and bosentan is a moderate CYP3A4 inducer. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Nimodipine must be given . Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. 2019 Oct;51(5):238-242. doi: 10.1097/JNN.0000000000000464. Aldesleukin, IL-2: (Moderate) Calcium channel blockers may potentiate the hypotension seen with aldesleukin, IL 2. In epileptic patients taking valproic acid, there is a 50% increase in the AUC of nimodipine. Blood pressure and heart rates should be monitored closely to confirm that the desired antihypertensive effect is achieved. Ceritinib: (Major) Avoid coadministration of nimodipine with ceritinib due to the risk of significant hypotension. Therapeutic actions Cetirizine; Pseudoephedrine: (Moderate) The cardiovascular effects of pseudoephedrine may reduce the antihypertensive effects produced by calcium-channel blockers. (Moderate) Olanzapine may induce orthostatic hypotension and thus enhance the effects of antihypertensive agents. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. Hudson, OH: Wolters Kluwer Health. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. Clough, Brendon; Tenii, Josephine; Wee, Claribel; Gunter, Elizabeth; Griffin, Tara; Aiyagari, Venkatesh. Spironolactone: (Moderate) Monitor blood pressure and reduce the dose of nimodipine as clinically appropriate if coadministration with spironolactone is necessary. Nimodipine is a CYP3A4 substrate and cobicistat is a strong CYP3A4 inhibitor. Methylphenidate Derivatives: (Moderate) Periodic evaluation of blood pressure is advisable during concurrent use of methylphenidate derivatives and antihypertensive agents, particularly during initial coadministration and after dosage increases of methylphenidate derivatives. Dosage adjustments of the antihypertensive medication may be required. Close monitoring of blood pressure is advised. Concurrent use may increase nimodipine exposure. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Pentobarbital: (Major) In epileptic patients taking phenobarbital with or without other enzyme-inducing anticonvulsants, there is a 7-fold decrease in the AUC of nimodipine due to hepatic enzyme induction. Asenapine: (Moderate) Secondary to alpha-blockade, asenapine can produce vasodilation that may result in additive effects during concurrent use of antihypertensive agents. Nimodipine is a CYP3A4 substrate and clarithromycin is a strong CYP3A4 inhibitor. Fluconazole: (Moderate) Fluconazole may decrease the clearance of calcium-channel blockers, including nimodipine, via inhibition of CYP3A4 metabolism. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. Amyl Nitrite: (Moderate) Nitroglycerin can cause hypotension. Adenosine: (Moderate) Use adenosine with caution in the presence of calcium-channel blockers due to the potential for additive or synergistic depressant effects on the sinoatrial and atrioventricular nodes. Chapter 31 . It crosses the placenta and, along with its metabolites, is excreted into breast milk. More study is needed regarding ginseng's effects on CYP3A4 and whether clinically significant drug interactions result. Federal government websites often end in .gov or .mil. Iloperidone: (Moderate) Secondary to alpha-blockade, iloperidone can produce vasodilation that may result in additive effects during concurrent use with antihypertensive agents. The most common side-effects include feeling dizzy or faint, and feeling sick (nausea). Nimodipine is a CYP3A4 substrate and spironolactone is a weak CYP3A4 inhibitor. Two case reports describe the use of nimodipine in breast-feeding mothers. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. Alfentanil may cause bradycardia. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. If concomitant use is unavoidable, monitor blood pressure and reduce the dose of nimodipine as clinically appropriate. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. Nimodipine is a CYP3A4 substrate and ribociclib is a strong CYP3A4 inhibitor. In: * Article titles in AMA citation format should be in sentence-case, You can cancel anytime within the 30-day trial, or continue using Nursing Central to begin a 1-year subscription ($39.95). Plasma levels are less than 5% of peak concentrations by 24 hours post-dose. Note: Your username may be different from the email address used to register your account. Although leading drug interaction texts differ in the potential for an interaction between diethylpropion and this group of antihypertensive agents, these effects are likely to be clinically significant and have been described in hypertensive patients on these medications. If the use of a macrolide antibiotic is necessary in a patient receiving nimodipine therapy, azithromycin is the preferred agent. Carbidopa; Levodopa; Entacapone: (Moderate) Concomitant use of antihypertensive agents with levodopa can result in additive hypotensive effects. PDR.net is to be used only as a reference aid. Codeine; Guaifenesin; Pseudoephedrine: (Moderate) The cardiovascular effects of pseudoephedrine may reduce the antihypertensive effects produced by calcium-channel blockers. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. Concurrent use may increase nimodipine exposure. "NiMODipine.". Echinacea is considered a moderate CYP3A4 inducer. Acetaminophen; Chlorpheniramine; Phenylephrine : (Moderate) Phenylephrine's cardiovascular effects may reduce the antihypertensive effects of calcium-channel blockers. Nimodipine is a CYP3A4 substrate and everolimus is a weak CYP3A4 inhibitor; concomitant use may increase plasma concentrations of nimodipine. This interaction can be therapeutically advantageous, but dosages must be adjusted accordingly. In addition, in epileptic patients taking carbamazepine and/or phenytoin with or without other enzyme-inducing anticonvulsants, there is a 7-fold decrease in the AUC of nimodipine due to hepatic enzyme induction. Monitor blood pressure and heart rate. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Patients should be monitored more closely for hypotension if nitroglycerin, including nitroglycerin rectal ointment, is used concurrently with a calcium-channel blocker. Etodolac: (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Nimodipine is a CYP3A substrate and pirtobrutinib is a weak CYP3A inhibitor. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. Atazanavir; Cobicistat: (Major) Avoid coadministration of nimodipine with cobicistat due to the risk of significant hypotension. Cimetidine: (Moderate) Cimetidine has been shown to increase the oral bioavailability of nimodipine due to cimetidine's effects on the cytochrome P-450 hepatic enzymes. Nimodipine is a CYP3A4 substrate. Nitroprusside: (Moderate) Additive hypotensive effects may occur when nitroprusside is used concomitantly with other antihypertensive agents. sharing sensitive information, make sure youre on a federal Desloratadine; Pseudoephedrine: (Moderate) The cardiovascular effects of pseudoephedrine may reduce the antihypertensive effects produced by calcium-channel blockers. Acetaminophen; Dichloralphenazone; Isometheptene: (Major) Isometheptene has sympathomimetic properties. Lower initial doses or slower dose titration of tetrabenazine may be necessary in patients receiving antihypertensive agents concomitantly. Nimodipine is a CYP3A4 substrate and erythromycin is a moderate CYP3A4 inhibitor. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Bethesda, MD 20894, Web Policies Sincalide: (Moderate) Sincalide-induced gallbladder ejection fraction may be affected by calcium-channel blockers. Based on this limited data, it is estimated that a nursing infant would receive less than 1% of the mother's weight-adjusted dosage of nimodipine. Patients taking antihypertensive agents may need to have their therapy modified. Nimodipine is rapidly absorbed following an oral dose but undergoes extensive first-pass metabolism, resulting in a low and variable bioavailability. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. Concomitant use with calcium channel blockers could enhance the rate of verteporfin uptake by the vascular endothelium, resulting in enhanced photosensitivity. Desogestrel; Ethinyl Estradiol: (Minor) Estrogen containing oral contraceptives can induce fluid retention and may increase blood pressure in some patients. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Tolmetin: (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Caution is advised with this combination. Ethinyl Estradiol; Norgestrel: (Minor) Estrogen containing oral contraceptives can induce fluid retention and may increase blood pressure in some patients. If a breast-feeding infant experiences an adverse effect related to a maternally ingested drug, healthcare providers are encouraged to report the adverse effect to the FDA. The safety and efficacy of nimodipine in children have not been established. Metoprolol: (Moderate) Nimodipine, a selective calcium-channel blocker, can enhance the antihypertensive effects of beta-blockers. Chapter 4: Screening of Attention, Cognition, Perception, and Communication Lifespan Neurorehabilitation: A Patient-Centered Approach from Examination to Intervention and Outcomes. Although often used together, concurrent use of calcium-channel blockers and beta-blockers may result in additive hypotensive, negative inotropic, and/or bradycardic effects in some patients. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease. Tranylcypromine: (Major) Avoid concomitant use of calcium-channel blockers and tranylcypromine due to the risk of additive hypotension. Patients should be monitored more closely for hypotension if nitroglycerin, including nitroglycerin rectal ointment, is used concurrently with a calcium-channel blocker. A non-controlled pharmacokinetic study in healthy volunteers found that the concurrent administration of ginseng with nifedipine resulted in a 30% increase in nifedipine peak concentrations. Ethinyl Estradiol; Norethindrone Acetate: (Minor) Estrogen containing oral contraceptives can induce fluid retention and may increase blood pressure in some patients. This may be attributed to the drug's high lipid solubility and specific binding to cerebral tissue. Drinking a full glass of water at the same time as taking the tablet can reduce these effects. Although no data are available, it is likely that nimodipine, a CYP3A4 substrate, may be affected by the coadministration of all barbiturates. Monitor blood pressure and heart rate. Nimodipine belongs to the class of pharmacological agents known as calcium channel blockers. Betaxolol: (Moderate) Nimodipine, a selective calcium-channel blocker, can enhance the antihypertensive effects of beta-blockers. Trazodone: (Minor) Due to additive hypotensive effects, patients receiving antihypertensive agents concurrently with trazodone may have excessive hypotension. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease. Hajizadeh Barfejani A, Rabinstein AA, Wijdicks EFM, Clark SL. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Monitor blood pressure and heart rate. Nimodipine can cause serious adverse reactions, including cardiovascular collapse and death, if it is accidentally given parenterally. False study results are possible in patients with drug-induced hyper- or hypo-responsiveness; thorough patient history is important in the interpretation of results. Ribociclib; Letrozole: (Major) Avoid coadministration of nimodipine with ribociclib due to the risk of significant hypotension. Nimodipine is a CYP3A substrate and lenacapavir is a moderate CYP3A inhibitor. Close observation and monitoring of blood glucose is necessary to maintain adequate glycemic control. Updated August 3, 2017. Niacin; Simvastatin: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents, especially calcium-channel blockers. We do not record any personal information entered above. Incidence of arterial hypotension in patients receiving peroral or continuous intra-arterial Nimodipine after aneurysmal or perimesencephalic subarachnoid hemorrhage. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. Its primary action is to reduce the number of open calcium channels in cell membranes, thus restricting influx of calcium ions into cells. Aspirin, ASA; Butalbital; Caffeine: (Major) In epileptic patients taking phenobarbital with or without other enzyme-inducing anticonvulsants, there is a 7-fold decrease in the AUC of nimodipine due to hepatic enzyme induction. Careful monitoring of blood pressure and hypotensive symptoms is recommended especially in patients with ischemic heart disease and in patients on antihypertensive agents. Patients receiving barbiturates and nimodipine concomitantly should be monitored closely for efficacy. DP - Unbound Medicine CONTENT: Nimodipine has been prescribed for patients with aSAH; however, little is known about factors to consider regarding dosing or patient-specific variables that may affect tolerability to nimodipine. Patients receiving barbiturates and nimodipine concomitantly should be monitored closely for efficacy. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease. Propranolol: (Moderate) Nimodipine, a selective calcium-channel blocker, can enhance the antihypertensive effects of beta-blockers. Istradefylline: (Moderate) Monitor blood pressure and reduce the dose of nimodipine as clinically appropriate if coadministration with istradefylline 40 mg daily is necessary. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Find information on Nimodipine (Nymalize) in Davis's Drug Guide including dosage, side effects, interactions, nursing implications, mechanism of action, half life, administration, and more. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Poor Utilization of Nimodipine in Aneurysmal Subarachnoid Hemorrhage. If coadministration is unavoidable, monitor blood pressure closely. These drugs include sildenafil (Viagra), tadalafil (Cialis, Adcirca), avanafil (Stendra) and vardenafil. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir: (Moderate) Anti-retroviral protease inhibitors are CYP3A4 inhibitors and may decrease the hepatic metabolism of nimodipine, leading to increased plasma concentrations of nimodipine. Josephine Tenii, PharmD BCPS BCCCP, is Neurocritical Care Pharmacist Specialist, University of Texas Southwestern Medical Center, Dallas, TX. These CBD candies offer a simple and flexible . Concurrent use of azithromycin was not associated with an increased risk of hypotension (OR 1.5, 95% CI 0.8-2.8). Although often used together, concurrent use of calcium-channel blockers and beta-blockers may result in additive hypotensive, negative inotropic, and/or bradycardic effects in some patients. Remifentanil: (Moderate) The risk of significant hypotension and/or bradycardia during therapy with remifentanil may be increased in patients receiving calcium-channel blockers due to additive hypotensive effects. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease. Carbinoxamine; Dextromethorphan; Pseudoephedrine: (Moderate) The cardiovascular effects of pseudoephedrine may reduce the antihypertensive effects produced by calcium-channel blockers. In addition, ritonavir and calcium channel blockers both prolong the PR interval and the manufacturer for ritonavir recommends caution during coadministration. Brompheniramine; Dextromethorphan; Phenylephrine: (Moderate) Phenylephrine's cardiovascular effects may reduce the antihypertensive effects of calcium-channel blockers. Close monitoring of blood pressure is advised. Alternatively, general anesthetics can potentiate the hypotensive effects of calcium-channel blockers. Nimodipine (C21H26N2O7) is a second-generation 1,4-dihydropyridine calcium channel blocker. HHS Vulnerability Disclosure, Help Mifepristone: (Moderate) Monitor blood pressure and heart rate if coadministration of nimodipine with mifepristone is necessary. Monitor blood pressure and heart rate. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Label oral syringes (one that cannot accept a needle) "For Oral Use Only"; nimodipine can cause serious adverse reactions including cardiovascular collapse and death if it is accidentally given parenterally.Administer the contents of the syringe (supplied by pharmacy) enterally; if given via nasogastric or gastric tube, flush the tube with 10 to 30 mL of saline afterward. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. modify the keyword list to augment your search. Norethindrone; Ethinyl Estradiol: (Minor) Estrogen containing oral contraceptives can induce fluid retention and may increase blood pressure in some patients. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. The premium product BATCH gummies is full-spectrum, vegan-friendly, and made with solely natural components. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Napumpujte ho antioxidantmi a vitamnmi! Lovastatin; Niacin: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents, especially calcium-channel blockers. Sustained-release 30-60 mg PO once daily. Although no data are available, it is likely that nimodipine, a CYP3A4 substrate, may be affected by the coadministration of all barbiturates. Following an oral dose but undergoes extensive first-pass metabolism, resulting in enhanced photosensitivity,! 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