[bellehill]

Our hospital is experiencing a nimodipine shortage so our patients are being started on nicardipine drips. I was curious if this shortage was nationwide and if anyone has seen an increase in the number of vasospasms when nicardipine is used.

[mommatrauma]

Nimodipine Capsules
Strength: 30 mg
Comment: Bayer has very limited emergency supplies of Nimotop capsules. The company recommends contacting wholesalers for product or an emergency drop shipment. Bayer expects more product to be available the first week of April. (03/29/05, University of Utah, Drug Information Service)

[Elenaster]

We haven't experienced a shortage recently, but our peak aneurysm season is over and we've had far more crani for tumor and head injuries lately, so I haven't been giving as much Nimodipine.

As for Nicardipine, I attended a presentation last summer by a neurosurgery fellow from Pitt, and he had conducted a study indicating that Nicardipine is as effective as Nimodipine at preventing vasospasm. Of course we still use Nimodipine, as I'm sure it's much less expensive.

[bellehill]

Thanks, elenaster, that is what I wanted to hear. We have had a large number of spasms lately...I'm trying to wrap my brain around the reason. I guess I'll look else where.

[Treb4K]

Originally Posted by bellehill

Our hospital is experiencing a nimodipine shortage so our patients are being started on nicardipine drips. I was curious if this shortage was nationwide and if anyone has seen an increase in the number of vasospasms when nicardipine is used.

we had nimodipine shortage a couple of months ago, but we never have to start our patients on cardene gtt. in our institution, we usually use cardene gtt to control the BP of our "untreated" SAH population. after intervention, (i.e. coiling or clipping) we generally keep these patients' BP HIGH according to the parameter set by the neurosurgeons.

[neuroRNX7]

We always used diltiazem tabs instead of nimodipine for treatment of vasospasm. One of our neurosurgeons researched and published an article that showed no significant changes in outcomes when dilt was used vs nimodipine, and the dilt is MUCH cheaper and was Q 6hr dosing vs Q 4.
Unfortunately, that particular MD has left our facility and we're now using nimodipine.
neuroRNX7

Originally Posted by bellehill

Our hospital is experiencing a nimodipine shortage so our patients are being started on nicardipine drips. I was curious if this shortage was nationwide and if anyone has seen an increase in the number of vasospasms when nicardipine is used.

[bellehill]

Originally Posted by neuroRNX7

We always used diltiazem tabs instead of nimodipine for treatment of vasospasm. One of our neurosurgeons researched and published an article that showed no significant changes in outcomes when dilt was used vs nimodipine, and the dilt is MUCH cheaper and was Q 6hr dosing vs Q 4.
Unfortunately, that particular MD has left our facility and we're now using nimodipine.
neuroRNX7

That is interesting, do you remember what journal he was published in? I would love to find that article.

[TNNURSE]

Nicardipine (cardene) is great stuff.It is also a calcium channel blocker .Our neurosurgeons actually inject a small dose of Nicardipine in the cerebral stents when they place them to prevent vasospasm immediately /postop.The only problem is Nicardipine builds up over time ya know.Like ...if you shut your drip off right now...it would take 50 hours for all the nicardipine to clear your body.So unlike Nimotop...unless you switch to the capsules...a Cardene drip is not feasible for the 21 days that your patient is at risk for Vasospasm.

[dorimar]

Forgive, me but I am new to neuro and learning. I thought the goal was to keep the bp low before aneurysm surgery, but high after surgery to prevent vasospasm. I've only read just a little on triple H therapy. If anyone would care to enlighten me further it would be appreciated. I have been on a reading frenzy the last 2 days and am getting confused. Keep the ICP down , keep the SBP up, vasoldilate, vasoconstrict.....

Doris

[gwenith]

Originally Posted by dorimar

I have been on a reading frenzy the last 2 days and am getting confused. Keep the ICP down , keep the SBP up, vasoldilate, vasoconstrict.....

Doris

Sounds about it for neuro:

Basically as soon as you have an SAH you have vasospasm problems and the issue is to maintain a MAP high enough to overcome that without creating further bleeding.

I call it eggshell nursing. You are walking on eggshells until you have that whole situation under control