Nimodipine is a medication intended to be given in a critical care setting to treat neurologic complications from subarachnoid hemorrhage and is only available as a capsule.

The U.S. Food and Drug Administration (FDA) is alerting healthcare professionals that nimodipine capsules should be given ONLY by mouth or through a feeding tube (nasogastric tube). This oral medication should NEVER be given by intravenous administration. FDA continues to receive reports of intravenous nimodipine use, with serious, sometimes fatal, consequences. Intravenous injection of nimodipine can result in death, cardiac arrest, severe falls in blood pressure, and other heart-related complications.

If the nimodipine capsule cannot be swallowed, e.g., at the time of surgery, or if the patient is unconscious, a hole should be made in both ends of the capsule with an 18 gauge needle, and the contents of the capsule extracted into a syringe. To help minimize administration errors, it is recommended that the syringe be labeled “Not for IV Use.” The needle should be removed from the syringe and the contents should then be emptied into the patient’s in situ nasogastric tube and washed down the tube with 30 mL of normal saline (0.9%).

According to the FDA, the following factors have been identified as contributing to this preventable medication error:

* Since some patients receiving nimodipine cannot swallow the capsules, they must receive the liquid from the capsules through a feeding tube. The nimodipine prescribing information has instructions for using a needle to make a hole in both ends of the capsule to remove the liquid contents with a syringe and then empty the contents into the feeding tube. Because a standard needle will not fit on an oral syringe, the needle must be attached to an intravenous syringe. The use of intravenous syringes to deliver nimodipine increases the chance that the medication will be given intravenously instead of by mouth or nasogastric tube.
* Most patients receiving nimodipine are hospitalized in critical care units and are already receiving intravenous medications.

For more information about the FDA Safety Alert on Nimodipine, click here

Capsule photo from http://www.drugs.com