[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Pharmacology](https://durgical.com/en/pharmacology/) › [Calcium channel blockers](https://durgical.com/en/pharmacology/classes/calcium-channel-blockers/) › Nimodipine

[Pharmacology](https://durgical.com/en/pharmacology/) · [Calcium channel blockers](https://durgical.com/en/pharmacology/classes/calcium-channel-blockers/)

# Nimodipine

A lipid-soluble dihydropyridine given by mouth after subarachnoid haemorrhage to reduce damage from delayed ischaemia. Never given IV from capsules.

Updated 2026-11-01

- Class: [Calcium channel blockers](https://durgical.com/en/pharmacology/classes/calcium-channel-blockers/)
- Ion channel: L-type voltage-gated calcium channel (CaV1.2)
- ATC code: C08CA06

⇅**L-type voltage-gated calcium channel (CaV1.2)**Nimodipine

ⓘ The figure shows amlodipine, another dihydropyridine, in the same binding site of the human CaV1.2 channel; no human structure with nimodipine bound is available.

**Target in 3D:** L-type voltage-gated calcium channel (CaV1.2). PDB structure 8WE8 (RCSB PDB, public domain). [View the structure at RCSB PDB](https://www.rcsb.org/structure/8WE8) · Drag to rotate · pinch to zoom

## Mechanism of action

Nimodipine blocks L-type calcium channels and, being highly lipid-soluble, reaches cerebral arteries well. After aneurysmal subarachnoid haemorrhage it reduces neurological deficits from delayed ischaemia; how it does so is not fully known, since it does not clearly reverse the angiographic vasospasm. It also lowers systemic blood pressure.

- Nimodipine crosses into the brain and blocks L-type calcium channels
- Less calcium entry in cerebral vessels and neurons
- Fewer deficits from delayed ischaemia after the bleed

## Pharmacokinetics

**Absorption**
Large first-pass loss, so bioavailability is low; food lowers it further

**Metabolism**
Liver, by CYP3A4

**Half-life**
Short early elimination, so it is given every 4 hours

## Indications

- Aneurysmal subarachnoid haemorrhage, to improve neurological outcome [Subarachnoid haemorrhage →](https://durgical.com/en/conditions/subarachnoid-haemorrhage/)

## Adverse effects

### Common

- Hypotension
- Headache
- Nausea
- Flushing and oedema

### Serious (rare, important)

- Cardiac arrest, collapse or death when capsule contents are injected IV
- Significant hypotension, which can worsen brain perfusion

## Contraindications

- Use with strong CYP3A4 inhibitors (some macrolides, azole antifungals, HIV protease inhibitors, nefazodone)

## Key interactions

**Strong CYP3A4 inhibitors**
Marked hypotension; contraindicated

**Strong CYP3A4 inducers (for example rifampicin, carbamazepine, phenytoin)**
Much lower levels and loss of effect

**Grapefruit juice**
Stronger and longer blood pressure lowering

## What is monitored

- Blood pressure and heart rate, often
- Neurological status

## Administration and safety

- By mouth or feeding tube only, never IV or by any other injection
- If the patient cannot swallow, capsule liquid is moved into an oral syringe that cannot take a needle, labelled for oral or tube use
- Given every 4 hours, preferably away from meals; grapefruit is avoided
- Several «-dipine» names look alike (nifedipine, nicardipine): the name is checked on every order

## Nursing care

- Check blood pressure before each dose and follow the protocol if it falls
- Assess neurological status regularly and report any new deficit
- Make sure only oral syringes are used for capsule contents

## Pregnancy and breastfeeding

Human data are limited; it is used in pregnancy only when the benefit justifies the risk.

## Memory aid

NIMOdipine is for the head: subarachnoid bleed, by mouth every 4 hours, NEVER in the vein.

## Test yourself

Think of the answer, then tap the question to see it.

## What is the main indication of nimodipine?

Aneurysmal subarachnoid haemorrhage, to reduce neurological deficits from delayed ischaemia.

## What happens if the contents of a nimodipine capsule are injected IV?

Severe cardiovascular events, including collapse, cardiac arrest and death; it is given only orally or by tube.

## Which drugs are contraindicated with nimodipine?

Strong CYP3A4 inhibitors such as clarithromycin, ketoconazole or ritonavir, because of significant hypotension.

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## Related drugs

- [Nicardipine](https://durgical.com/en/pharmacology/nicardipine/)
- [Nifedipine](https://durgical.com/en/pharmacology/nifedipine/)
- [Amlodipine](https://durgical.com/en/pharmacology/amlodipine/)

## Related conditions

- [Subarachnoid haemorrhage](https://durgical.com/en/conditions/subarachnoid-haemorrhage/)

[← Back to the class: Calcium channel blockers](https://durgical.com/en/pharmacology/classes/calcium-channel-blockers/)

Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.

Sources: [DailyMed - NIMODIPINE capsule, liquid filled](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=e65d5108-22a2-4d87-a78d-15606f3cc9e2) (DailyMed (U.S. National Library of Medicine), 2026); [ATCDDD - ATC/DDD Index](https://atcddd.fhi.no/atc_ddd_index/?code=C08CA06) (WHO Collaborating Centre for Drug Statistics Methodology, 2026); Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th ed., ch. 31 (McGraw Hill, 2023).

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Representative model, for educational purposes only.

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