Nemotan (Nimodipine) 30 mg, 30 tablets

What is Nemotan?

Nemotan is a medicine known internationally as Nimodipine. It comes in the form of film-coated tablets, each containing 30 mg of Nimodipine. This medication is part of the calcium channel blockers pharmacotherapeutic group, specifically those that selectively affect blood vessels.

What are the uses of Nemotan?

Nemotan is primarily used for the prevention and treatment of ischemic neurological disorders caused by cerebral vasospasm following a subarachnoid hemorrhage due to aneurysm rupture. This treatment typically follows prior intravenous therapy with a Nimodipine infusion solution.

What precautions should be taken before using Nemotan?

Contraindications

• Hypersensitivity to Nimodipine or any other ingredient in the tablet.
• Recent myocardial infarction or unstable angina within the last month.
• Concurrent use with rifampicin, or antiepileptic drugs such as phenobarbital, phenytoin, or carbamazepine, which can significantly reduce the efficacy of Nemotan.
• Children under 18 years old due to unestablished safety and efficacy.

Precautions

• Avoid in patients with traumatic subarachnoid hemorrhage due to insufficient information on risk-benefit.
• Use cautiously in patients with severe intracranial pressure or brain edema, as Nimodipine may exacerbate these conditions.
• Monitor blood pressure in patients with hypotension (systolic blood pressure below 100 mmHg).
• Patients with liver cirrhosis may require close monitoring of blood pressure due to reduced drug clearance.
• Treatment should not exceed seven days and avoid simultaneous use with other forms of Nimodipine.
• Be cautious when using drugs that inhibit or induce cytochrome P450 3A4 as they can alter Nimodipine metabolism.

How should Nemotan be taken?

Dosage

For subarachnoid hemorrhage due to aneurysm rupture:

• Preventive use in adults: Two tablets every 4 hours (total daily dose of 360 mg) with water. Start within 4 days of the hemorrhage and continue for 21 days.
• Post-surgery: Do not stop Nemotan; maintain the dosage to complete the 21-day treatment.

For patients experiencing side effects, the dosage should be reduced or treatment discontinued.

Administration Method

• Take orally.
• Swallow tablets whole with sufficient fluid, regardless of food intake.
• Maintain at least 4-hour intervals between doses.
• Avoid grapefruit juice as it increases plasma concentration of Nimodipine.

What interactions should you be aware of with Nemotan?

Drug Interactions

• Do not use with other forms of Nimodipine.
• Drugs affecting cytochrome P450 3A4 can influence Nimodipine’s metabolism.
• Avoid using with rifampicin or antiepileptic drugs (phenobarbital, phenytoin, carbamazepine).
• Monitor blood pressure if used with cytochrome P450 3A4 inhibitors like macrolide antibiotics, HIV protease inhibitors, azole antifungals, nefazodone, and fluoxetine.
• Co-administration with grapefruit juice should be avoided.
• Drugs like quinapristin/dalfopristin, valproic acid, and cimetidine can increase Nimodipine plasma concentration.
• Be cautious with antihypertensive drugs as they can enhance hypotensive effects.

Safe Combinations

• No interactions observed with diazepam, digoxin, glibenclamide, indomethacin, ranitidine, and warfarin.

What are the possible side effects of Nemotan?

Common Side Effects

• Hypotension and vasodilation

Less Common Side Effects

• Thrombocytopenia
• Allergic reactions, rash
• Headache, dizziness
• Hyperkinesia, tremor
• Palpitations, tachycardia
• Fainting, edema
• Nausea, constipation, diarrhea, flatulence

Rare Side Effects

• Bradycardia
• Intestinal obstruction
• Transient liver enzyme elevation
• Injection site reactions, thrombophlebitis at infusion site

How to store Nemotan?

Store Nemotan in a dry, dark place at temperatures not exceeding 25°C (77°F). Keep it out of reach of children and do not use it past its expiration date.

What to do in case of an overdose?

Symptoms

• Significant drop in blood pressure
• Tachycardia or bradycardia
• Gastrointestinal issues like nausea

Treatment

• Discontinue Nemotan immediately.
• Perform gastric lavage and administer activated charcoal.
• For severe hypotension, intravenous dopamine or norepinephrine may be administered.
• Subsequent treatment should be symptomatic.

For any uncertainties or concerns about taking Nemotan, it is important to consult with a healthcare professional for guidance.