[bestblondRN]

I assume you're giving Nimodipine for cerebral vasospasm prevention, so, in that case, the way to give it is to squirt the contents of the capsule under the tongue for absorption through the buccal mucosa. NEVER, EVER crush an enteric coated tablet--it isn't designed for absorption at the same rate or in the same manner as a liquid.

Worst case scenario--you use a Ca+ channel blocker like Nimodipine incorrectly and drop the patient's BP, which is keeping their CPP up and you create a hypoxic or anoxic injury. Bad news..........

[mbrian46]

I've read somewhere that giving Nimotop sl decreases effectiveness. Anyone verify this? We have gel caps which pts. swallow if necessary or we puncture the cap and give it down a NG tube.

[rstewart]

Much of the apparent confusion on this thread is the result of participants practicing in different countries. In the United States Nimodipine (branded Nimotop) is available in capsule form. Outside of the U.S. Nimodipine is available in several additional forms including extended release tablets and even IV forms.

In the United States the capsule should be given orally or if necessary the contents should be removed via syringe and placed down an NG tube and flushed with Normal Saline----it should NOT be given sublingually or otherwise as was suggested.

Finally, as mentioned by several posters, in countries where an extended release tablet is available, the tablets should not be crushed for NG administration; rather another form should be selected.

[prn nurse]

In our NICU, we gave Nimotop via the ng or po. Either way, here is what we did. We placed the big rubbery capsule in a 30 cc plastic med cup of room temp water. let it set about 15-20 minutes and go back....it has basically dissolved. stir it a bit with a tongue blade and then strain it thru a 4x4 into another cup. it is then ready to give to patient with not a drop wasted.
One of our docs said when patients are able to swallow and swallow those big capsules that too many pass on thru the body unassimilated.

[Jonty45]

Originally posted by Jonty45
We use Nimodipine (NIMOTOP) in my Neuro Unit in the UK. It is definitely enteric coated and it is crushed for patients who are unable to take oral medication. We have discussed the effects with our Clinical Pharmacy Specialist and he says that it contravenes the license and should not be done.!! Our medics insist that we carry on the present practice. They don't say where they will be when litigation commences! They also decline to give written orders for the practice... still we outnunmber them and we have sufficient witnesses on our side. ). Our pharmacy are able to produce it in liquid form but the Pharmaceutical company refuse to grant us a license to do so. Funny old world?

Further to my last post I thought that there wasn't a great deal of "coat".. turns out it's film coated to facilitate easier swallowing!! Therefore crushing it does no harm except it absorbs a tad faster...

And... by the by.. if it's in a gelatine capsule is that not also designed for slow release?

[globalRN]

If anything is enteric coated for sustained release(SR)of the medication:
then absolutely do not crush and give: that is the wrong medication delivery route.

When I was in neuro, there was an order for Adalat SR. which everyone was crushing and giving via NG. Questioned the order and the doctor decided not to give.
Anyway, it is our license on the line if something adverse happens
because any 'reasonable nurse should have forseen the outcome'. Don't think that the 'doctors order' excuse will give you immunity from loss of license or protect you from litigation.

BTW, if any of you own a handheld or PDA, there are great drug references out there: some free and others not. I have lots of programs on mine to help me give up-to-date care at the point of care.
With one check, one can tell that Nimotop=nimodopine and that in the US and Canada it only comes in capsule form plus a whole lot of other drug data too.

[rails]

THANK YOU ALL FOR YOUR VALUABLE INSIGHT!!!! I am sure where I am coming the next time I face a practice/reflection conundrum!!!!
Ciao and Keep Smiling from the aussie nurse down-under!!