Nimodipine

Antihypertensive (calcium channel blocker)

Dosing

Bipolar: Start 30 mg TID, raise by 15 mg every 10 days to target of 240-480 mg/day, divided TID

Vascular depression: Start 30 mg TID, raise by 15 mg every 10 days to target of 90 mg TID

Tremor: 30 mg qid

INTERACTIONS: CYP3A4 inducers/inhibitors alter its levels (including grapefruit which raises it). Levels 2x higher in elderly. FOOD: Do not take within 1 hr of meal (food lowers levels by 30-50%).

SHORT HALF-LIFE: 1-2 hr. Generic but expensive.

Management

Possibly treats mania, rapid cycling (4 episodes per year), ultra-rapid cycling (more frequent), and bipolar-anxiety. Similar to isradipine and amlodipine, while verapamil has a different mechanism.

Treats vascular depression through calcium-signalling and improving vascular flow.

TOLERABILITY: Dizziness, GI upset, rare edema.

RISKS: Get medical approval in heart disease (AV conduction delays). Monitor BP (hypotension risk). Very rare LFT elevation.

EMR Text