Nimodip
✅ Manages hypertension
✅ Prevents stroke
✅ Enhances blood flow
✅ Reduces migraine frequency
✅ Alleviates brain-related issues
Nimodip contains Nimodipine.
✓ Medically reviewed by Morgan Ellis — Pharmacy Researcher · 8 years experience · Last reviewed: May 2026
⚡ Quick Answer — What is Nimodip?
Nimodip is an oral nimodipine (30 mg) tablet — a cerebral-selective dihydropyridine calcium channel blocker specifically used to prevent and reduce the severity of cerebral vasospasm and delayed cerebral ischaemia (DCI) following aneurysmal subarachnoid haemorrhage (aSAH). Dosing: 60 mg every 4 hours (360 mg/day) for 21 consecutive days, started within 96 hours of the bleed. Nimodipine preferentially dilates cerebral arteries over peripheral ones, reducing the incidence of vasospasm-related neurological deficits without causing significant systemic hypotension at standard doses. Common side effects: hypotension, headache, nausea, flushing.
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What Is Nimodip?
Nimodip is an oral tablet containing nimodipine 30 mg. Nimodipine is a cerebral-selective dihydropyridine calcium channel blocker — unlike other CCBs (amlodipine, nifedipine), it preferentially dilates cerebral arteries with minimal effect on peripheral blood pressure.
Nimodipine is the only calcium channel blocker with a neurology indication: prevention of ischaemic neurological deficits (vasospasm) following aneurysmal subarachnoid haemorrhage (SAH). The landmark BIDA trial (1983) demonstrated a ~40% reduction in cerebral infarction and improved neurological outcomes with the standard 21-day oral protocol. Nimodip is manufactured by a WHO-GMP certified facility and is bioequivalent to the originator brand Nimotop (Bayer).
How Does Nimodip (Nimodipine) Work?
Nimodipine blocks L-type voltage-gated calcium channels, but unlike other calcium channel blockers (amlodipine, nifedipine), it has preferential affinity for cerebral vascular smooth muscle. This cerebral selectivity means it dilates brain arteries more than peripheral ones, making it uniquely suited for preventing vasospasm after subarachnoid haemorrhage.
Beyond vasodilation, nimodipine may have neuroprotective effects — it reduces calcium influx into neurons during ischaemia, which attenuates excitotoxic cell death. Clinical trials (the landmark British Aneurysm Nimodipine Trial) demonstrated a significant reduction in poor outcomes, even though angiographic vasospasm rates were not dramatically different — suggesting the benefit is partly neuroprotective.
Indications
- Prevention of cerebral vasospasm and delayed cerebral ischaemia after aneurysmal subarachnoid haemorrhage — the only approved indication
- Off-label uses: migraine prophylaxis, vascular dementia (limited evidence), traumatic subarachnoid haemorrhage
Dosing — The 21-Day Protocol
| Parameter | Standard Protocol |
|---|---|
| Dose | 60 mg (two 30 mg tablets) |
| Frequency | Every 4 hours |
| Total daily dose | 360 mg/day |
| Duration | 21 consecutive days |
| Start | Within 96 hours of haemorrhage |
| Hepatic impairment | 30 mg every 4 hours (halved dose) |
Critical: Nimodipine tablets must be swallowed whole, not crushed. For patients unable to swallow, the contents can be extracted via syringe and administered through a nasogastric tube — but never inject the oral solution intravenously (fatal cases of inadvertent IV administration of oral nimodipine have occurred). Take at least 1 hour before or 2 hours after meals for optimal absorption.
Side Effects
Common: hypotension (dose-related, usually mild), headache, nausea, flushing, peripheral oedema.
Less common: dizziness, tachycardia, rash, GI upset, bradycardia.
Serious: severe hypotension (especially in patients with pre-existing low blood pressure or on other antihypertensives), ileus (in critically ill SAH patients), hepatotoxicity (rare — elevated transaminases).
Warnings and Precautions
- Hypotension. Nimodipine can cause significant blood pressure drops, particularly in hypovolaemic SAH patients or those on other antihypertensives. Monitor BP every 1–2 hours during the initial 48 hours. Reduce dose to 30 mg every 4 hours (from every 2 hours) if systolic drops below 90 mmHg.
- Hepatic impairment. Nimodipine undergoes extensive first-pass hepatic metabolism. In cirrhosis, bioavailability increases markedly — halve the dose and monitor for hypotension and bradycardia.
- Cerebral oedema / raised ICP. Use with caution in patients with cerebral oedema or severely elevated intracranial pressure.
- Grapefruit juice. Inhibits CYP3A4 metabolism of nimodipine, doubling plasma levels. Avoid grapefruit products during the 21-day protocol.
- Epilepsy. Use nimodipine cautiously in patients with epilepsy — although it is not epileptogenic, seizures are a common SAH complication and drug interactions with anticonvulsants (especially enzyme inducers like phenytoin and carbamazepine) are clinically significant.
- Pregnancy category C. Teratogenic in animals at high doses. Use only if benefit outweighs risk.
- Breastfeeding. Nimodipine is excreted in breast milk. The clinical significance is uncertain — use with caution.
Contraindications — Who Should NOT Take Nimodip
- Known hypersensitivity to nimodipine, other dihydropyridines or any excipient
- Concurrent use with rifampicin (reduces nimodipine to subtherapeutic levels via CYP3A4 induction)
- Concurrent use with strong CYP3A4 inhibitors (ketoconazole, itraconazole, ritonavir) without dose reduction
- Unstable angina or recent MI (within 4 weeks)
Drug Interactions
- Other antihypertensives & calcium channel blockers: Additive hypotension
- CYP3A4 inhibitors (ketoconazole, fluconazole, macrolide antibiotics, grapefruit juice): Increase nimodipine levels significantly
- CYP3A4 inducers (rifampicin, phenytoin, carbamazepine, phenobarbital): Reduce nimodipine levels, potentially to sub-therapeutic
- Beta-blockers: Additive negative chronotropic effect — monitor heart rate
- Nephrotoxic drugs: Nimodipine may worsen renal function in SAH patients receiving concurrent nephrotoxics
Storage Instructions
- Store at room temperature, 15–25°C. Protect from light — nimodipine is light-sensitive.
- Keep in original amber blister packaging until use.
- Do not store in the bathroom.
- Keep out of reach of children.
- Do not use after the expiry date.
Related Categories on MedsBase
Frequently Asked Questions
What is Nimodip used for?
Nimodip contains nimodipine 30 mg and is used to prevent cerebral vasospasm and delayed cerebral ischaemia following aneurysmal subarachnoid haemorrhage (aSAH). It is the only drug proven to improve neurological outcomes after SAH.
Why is nimodipine given every 4 hours and not twice daily?
Nimodipine has a short half-life (1–2 hours orally). The every-4-hour dosing ensures continuous therapeutic levels throughout the 21-day critical vasospasm period (days 3–14 are highest risk). Missing doses creates gaps in protection.
Is nimodipine the same as nifedipine or amlodipine?
All three are dihydropyridine calcium channel blockers, but nimodipine is uniquely cerebral-selective. Nifedipine and amlodipine primarily target peripheral and coronary arteries and are used for hypertension/angina. They are not interchangeable — only nimodipine has evidence for SAH outcomes.
Why must nimodipine never be given intravenously?
Oral nimodipine formulations contain excipients not suitable for IV injection. Inadvertent IV administration has caused cardiovascular collapse and death. When oral dosing is impossible (unconscious patients), nimodipine should be given via nasogastric tube, not injected.
Does nimodipine actually prevent vasospasm?
Interestingly, nimodipine does not significantly reduce angiographic vasospasm. Its benefit appears to be primarily neuroprotective — reducing ischaemic neuronal damage from vasospasm rather than preventing the spasm itself. The clinical result is fewer patients with permanent neurological deficits.
Can I take nimodipine with grapefruit juice?
No. Grapefruit juice inhibits CYP3A4, significantly increasing nimodipine levels and the risk of hypotension. Avoid grapefruit throughout treatment.
What happens if a dose is missed?
Take the missed dose as soon as possible. If it is nearly time for the next dose, skip the missed one and continue the schedule. Given the short half-life, any gap reduces protection during the critical vasospasm window.
Is nimodipine used for migraine?
Nimodipine has been studied for migraine prophylaxis with mixed results. Some patients benefit, but it is not a first-line migraine preventive — propranolol, topiramate, and valproate have stronger evidence. It is used off-label when other options have failed or are contraindicated.
Can nimodipine lower blood pressure too much?
Yes — hypotension is the main clinical concern. In SAH patients, maintaining adequate cerebral perfusion pressure is critical. Blood pressure should be monitored regularly, and the dose may need to be halved (30 mg every 4 hours) in patients with hepatic impairment or significant hypotension.
How long is the treatment course?
The standard protocol is 21 consecutive days, regardless of whether vasospasm occurs. The highest-risk period is days 3–14, but treatment extends to day 21 to cover late vasospasm events.
Is Nimodip the same as Nimotop?
Both contain nimodipine 30 mg. Nimotop is the original Bayer brand. Nimodip is a bioequivalent generic at a lower cost.
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| Strength | 30 mg |
|---|---|
| Quantity | 30 Tablet/s, 60 Tablet/s, 90 Tablet/s, 180 Tablet/s |
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