Nimodipine: Evidence for clinically significant gastrointestinal side-effects

Abstract

Nimodipine, now widely used for treatment and prevention of cerebrovascular spasm, is regarded as a safe drug. Despite a preferential action on cerebral vessels, there is clinical and experimental evidence of effects on systemic vascular and intestinal smooth muscle cells. Gastro-intestinal side-effects, however, have not been reported in clinical studies dealing with treatment of vasospasm following subarachnoid haemorrhage. We report on a patient with subarachnoid haemorrhage who developed an acute life-threatening pseudo-obstruction of the colon, a variant of adynamic ileus, while being treated with intravenous nimodipine. The relationship between this complication and calcium antagonist therapy is discussed and therapeutic strategies are presented. We conclude that neurosurgeons and neurologists should be aware of calcium antagonist--related ileus in patients treated with nimodipine.

Intestinal Pseudo-Obstruction Caused by Diltiazem in a Neutropenic Patient

“…Such reports include diltiazem poisoning in a 30-year- old man, 4 diltiazem treatment for ischemic heart disease in a 76-year-old man, 5 nifedipine and diltiazem combination therapy for angina pectoris in a 41-year-old male, 6 diltiazem poisoning in a 30-year-old man, verapamil intoxication in a 23-year-old man and a 73-year-old woman, 7,8 and use of nimodipine in patients with subarachnoid hemorrhage. 9,10 Of note, intestinal pseudo-obstruction and ileus are listed as a precaution in the prescribing information for nimodipine. 15 A causal relationship has not been established.…”

“…3 Although calcium-channel blockers do not commonly cause hypomotility, they have also been reported to cause intestinal pseudo-obstruction. 4–10 We describe a case of intestinal pseudo-obstruction in a neutropenic patient who received diltiazem for atrial fibrillation.…”

Potential Association Between Acute Colonic Pseudo-Obstruction (Ogilvie Syndrome) and Oral Nimodipine: Report of Two Cases

“…However, no cerebral aneurysm was identified in the angiographic studies. Hund et al reported a similar complication after using intravenous nimodipine in a patient who had a SAH secondary to a ruptured aneurysm of the anterior communicating artery [13]. They also mentioned four prior patients with aneurysmal SAH who developed abdominal distension after intravenous nimodipine [13].…”

Association Between Acute Colonic Pseudo-Obstruction (Ogilvie Syndrome) And Nimodipine Use. Case Series And Comprehensive Review

“…However, no cerebral aneurysm was identi ed in the angiographic studies. Hund et al reported in 1990 a similar complication after the use of intravenous nimodipine in a patient with SAH secondary to an aneurysm of the anterior communicating artery [15]. They also mentioned four previous cases of SAH in which the patients developed abdominal distention after intravenous nimodipine.…”