Nimodipine has tserebrovazodilati-ating effect, prevents or eliminates vasospasm triggered by various vasoactive substances (including serotonin, prostaglandins, and histamine), has neuro- and psychotropic activity.
In patients with acute stroke nimodipine, expanding blood vessels brain, improve cerebral circulation. The additional perfusion usually more pronounced in damaged before enough blood perfused brain. The use of nimodipine can winstrol only cycle significantly reduce the mortality and incidence of subarachnoid hemorrhage occurs due to ischemic neurological disorders.
The concentration of nimodipine and its metabolites in breast milk significantly higher than the concentration in the blood plasma. After intravenous administration of nimodipine concentration in CSF is about 0.5% of the plasma concentration. Metabolism and excretion. Nimodipine taboliziruetsya Me-dihydropyridine ring by dehydrogenation and oxidative ester cleavage. Three principal metabolite, found in plasma, have no clinically significant pharmacological activity. Effect of nimodipine on the activity of liver enzymes has not been studied. In humans the metabolites to 50% of the kidneys and 30% in the bile.
Prevention and treatment of ischemic neurological disorders caused by a spasm of cerebral vessels on the background of subarachnoid hemorrhage due to the rupture of the aneurysm.
In view of the seriousness of the evidence the only absolute contraindication is the idiosyncrasy, the age of 18 years. The caution Nimotop is prescribed in the following situations: bradycardia, hypotension (systolic pressure less than 100 ml.rt.st.), myocardial ischemia, severe heart failure, intracranial hypertension, generalized edema of the brain, liver and kidney failure. Preperaty contains 23.7 percent by volume of ethanol, it should be taken into account in the appointment of suffering from alcoholism to the deterioration of the metabolism of alcohol, pregnant or breastfeeding women and patients with liver diseases, epilepsy. Use during pregnancy and lactation. Application Nimotop during pregnancy always requires careful assessment of the ratio benefit and risk factors, taking into account the severity of the clinical picture.
Dosing and dosing regimen is recommended to comply with the following dosing regimen: Intravenous infusion. At the beginning of therapy administered within 2 hours to 1 mg per hour nimodipine (Nimotop 5 ml infusion solution), about 15 ug / kg / hour. With good tolerance (especially in the absence of a significant reduction in blood pressure) through 2 chasa dose was increased to 2 mg nimodipine per hour (approximately 30 ug / kg / hour). . The starting dose for patients weighing less than 70 kg or labile blood pressure should be 0.5 mg nimodipine hour infusion Nimotop solution used for continuous intravenous infusion through a central catheter using an infusion pump and a three-way stopcock at the same time with one of the following solutions: 5% dextrose, 0.9% sodium chloride, Ringer’s solution, Ryngera magnesium solution, the solution is dextran 40 or 6% hydroxyethyl starch in a ratio of about 1: 4 (Nimotop / other solution). As a concomitant infusion may also be used mannitol, human albumin or blood. The solution can not be added in Nimotop infusion vessel or mixed with other drugs. It is recommended to continue the administration of nimodipine in the course of anesthesia, surgery and angiography. For connecting a polyethylene tube through which flows Nimotop solution channel receipt accompanying the solution and the central catheter is necessary to use triple-channel shut-off valve.The prophylactic use. Intravenous therapy with nimodipine must start no later than 4 days after the hemorrhage, and continue throughout the period of maximum risk of vasospasm, ie up to 10-14 days after subarachnoid hemorrhage. after the end of infusion winstrol only cycle therapy for the next 7 days is recommended oral tablet formulation of nimodipine in a dose of 60 mg x 6 times day at intervals of 4 hours. The therapeutic use. If you already have a place ischemic neurological disturbances caused by vasospasm due to subarachnoid hemorrhage, fluid therapy should be started as early as possible and to hold for at least 5 but not more than 14 days. After the end of the infusion therapy for the next seven days it is recommended oral tablet form nimodipine 60 mg six times per day (every 4 hours). If, during therapeutic or prophylactic use solution Nimotop performed surgery haemorrhage, intravenous therapy nimodipine should continue for at least 5 days after surgery. Introduction into brain cistern. During surgery, a freshly prepared solution of nimodipine (Nimotop 1 ml infusion solution and 19 ml of Ringer’s solution) preheated to an average temperature of the body may be administered intracisternally. The solution should be used immediately after preparation. If the patient has an adverse reaction to the use of the drug, should either reduce the dose or discontinue therapy with nimodipine. In severe hepatic dysfunction, especially in liver cirrhosis, the bioavailability of nimodipine may be increased due to lower intensity of the primary metabolism and slowing metabolic inactivation. The consequence of this may be a worsening of the primary and side effects of the drug, in particular its hypotensive effect. In such cases the dose should be reduced by the extent of lowering blood pressure; if necessary, treatment should be interrupted. Nimodipine is sensitive to light, so avoid direct exposure to sunlight on it: to use glass syringes and connecting tube of black, brown, yellow or red color; In addition, infusion pumps and tubing expedient opaque paper wrap. In diffuse daylight or artificial light Nimotop can be used for 10 hours without special protective measures. Nimodipine, the active substance Nimotop infusion solution is absorbed by polyvinyl chloride, for parenteral administration, it can only be used with plastic pipes systems.
Side effects: Allergic reactions: itching, rash. On the part winstrol only cycle of the gastrointestinal tract: diarrhea disorders, nausea, diarrhea, dry mouth, change in appetite, in rare cases – ileus. From the nervous system:headache when taking the tablets – dizziness. Since the cardiovascular system: a significant reduction in blood pressure, especially at elevated baseline values, “tides” of blood to the face, bradycardia, feeling of heat in the head, excessive sweating, tachycardia, development or exacerbation had congestive heart failure and myocardial ischemia. On the part of the system hematopoiesis: thrombocytopenia.Influence on laboratory parameters: increase in transaminases, alkaline phosphatase and gamma-glutamyl transferase, impairment of renal function with increasing concentrations of urea and / or creatinine in blood plasma. In the treatment should be considered that the product contains 23.7% by volume of the alcohol (200 mg of alcohol per 1 ml) and 17% polyethylene glycol 400. Local reactions: phlebitis (Nimotop infusion when administered in solution without concomitant peripheral vein solution).
In acute overdose Nimotop following symptoms may occur:. Significant reduction in blood pressure, tachycardia or bradycardia
When the acute symptoms of overdose occur the use of nimodipine should be stopped immediately. Events for emergency assistance are defined by its symptoms of an overdose. If there is a significant drop in blood pressure, type intravenous dopamine or norepinephrine. Since specific antidotes nimodipine is not known, the further treatment of other side effects should be symptomatic.
The interaction with other drugs
Prolonged use of nimodipine with fluoxetine results in increased concentrations of nimodipine in plasma on average 50%. The concentration of fluoxetine significantly decreased, while the active metabolite of fluoxetine – norfluoxetine is not changed.
Simultaneous prolonged use of nimodipine and nortriptyline leads to a slight decrease in the concentration of nimodipine (wherein nortriptyline plasma concentration does not change). In patients undergoing long-term treatment with haloperidol, drug interactions detected nimodipine haloperidol.
The simultaneous intravenous administration of nimodipine and zidovudine leads to a significant increase for the AUC of zidovudine and reducing its volume distribution and clearance.
In combination with drugs to lower blood pressure:
- ACE inhibitors
- AT-1 blocker receptors
- other calcium antagonists
- phosphodiesterase inhibitors
Nimotop may enhance the hypotensive effect.
Simultaneous treatment of potentially nephrotoxic drugs (eg, aminoglycosides, cephalosporins, furosemide) may cause renal dysfunction. In the case of such treatment, and in patients with renal insufficiency, treatment should be carefully monitored. Upon detection of renal function receiving nimodipine should be discontinued. Nimotop infusion solution contains 23.7% alcohol by volume, it is necessary to consider the possible interaction of alcohol with other drugs.
In a study in monkeys co-administration of zidovudine and intravenous bolus administration of winstrol only cycle nimodipine decreased the clearance of zidovudine.
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Because of the possibility of the use of nimodipine vertigo may interfere with the ability to drive vehicles and mechanisms. When using Nimotop infusion solution, this factor does not usually matter. anabolic steroids online pharmacy
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