Issues for surgery
For treatment of ischaemic neurological defects following subarachnid haemorrhage (SAH) - progression of ischaemia if omitted.
Risk of hypotension when continued.
Advice in the perioperative period
Elective and emergency surgery
Continue – monitor BP.
the components of combination products as separate medicines perioperatively.
Post-operative advice
Restart post-operatively when next dose is due.
Monitor BP.
Interactions with common anaesthetic agents
Inhalational Anaesthetics
See also Hypotension below.
Nimodipine may reduce the minimum alveolar concentration (MAC) of inhalational anaesthetics by up to 20%.
Hypotension
Nimodipine can increase the risk of hypotension when used concomitantly with remifentanil or inhalational/intravenous anaesthetics.
Neuromuscular blocking drugs (NMBDs)
Nimodipine may prolong neuromuscular blockade when used concomitantly with NMBDs. The clinical significance is unknown, but bear the potential interaction in mind in case of unexpected response to treatment.
Dantrolene
There is a potential interaction between intravenous dantrolene and calcium-channel blockers leading to acute hyperkalaemia and cardiovascular collapse. This interaction has occurred in animal studies with some calcium-channel blockers (CCBs). It is recommended that co-administration of nimodipine with dantrolene should be avoided.
Interactions with other common medicines used in the perioperative period
Hypotension
Nimodipine can increase the risk of hypotension when used concomitantly with droperidol or prochlorperazine.
Macrolide antibiotics
Macrolide antibiotics (e.g. clarithromycin, erythromycin), which are inhibitors of CYP3A4, may increase the effects of nimodipine leading to hypotension. Monitor the patient and consider reducing the dose of the nimodipine if necessary.
Whilst single surgical prophylactic doses should not pose a problem, continued post-operative treatment may require close monitoring. Consult current product literature.
Further information
The use of nimodipine is confined to prevention and treatment of vascular spasm following aneurysmal subarachnoid haemorrhage. Additionally, it appears to have some effect in blunting the cardiovascular response to intubation and incision.
References
Baxter K, Preston CL (eds), Stockley’s Drug Interactions (online) London: Pharmaceutical Press. http://www.medicinescomplete.com [Accessed on 12th April 2019]
British National Formulary (online) London: BMJ Group and Pharmaceutical Press. http://www.medicinescomplete.com [Accessed on 12th April 2019]
Dantrolene Sodium. In: Brayfield A (Ed), Martindale: The Complete Drug Reference. London: The Royal Pharmaceutical Society of Great Britain. http://www.medicinescomplete.com [Accessed 9th October 2019]
Diazepam. In: Brayfield A (Ed), Martindale: The Complete Drug Reference. London: The Royal Pharmaceutical Society of Great Britain. http://www.medicinescomplete.com [Accessed 12th April 2019]
Scarth E, Smith S. Drugs in Anaesthesia and Intensive Care, 5th Edition. Oxford University Press; 2016
Summary of Product Characteristics – Nimotop® (nimodipine) 30 mg Tablets. Bayer plc. Accessed via www.medicines.org.uk 09/10/2019 [date of revision of the text October 2017]
The Joint Task Force on non-cardiac surgery: cardiovascular assessment and management of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA). 2014 ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assessment and management. European Heart Journal. 2014; 35:2383-2431