Published Jun 22, 2002
Was wondering efficacy of nimodipine given via NG (crushed) when enteric coated?? :idea:
NurseDennie, BSN, RN
Don't crush enteric-coated tabs!
I've never seen nimotop come in an enteric coated tab. Are you sure you're talking about nimodipine?
They were capsules when I was in neuro. We got the med out of the little capsule whatever way seemed most reasonable at the time. Some of the nurses put them in hot water and let the geltine capsule dissolve and some of us stuck the capsule with a needle and squirted out the liquid.
They had to be given religiously within minutes of the time scheduled dose time.
I am positive these tabs are enteric coated. But it's interesting that they come in capsules. We have these tabs at ward level and may warrant a pharmacy discussion about capsule availability......
In our unit, giving nimotop is usually by way of mouth or NG because as you know, mot aneurysm patients are very very lethargic and rarely alert at first. If they can't swallow it and don't have an NG, I squirt the contents of the soft capsule into a syringe and into their mouth. Its very important for neuro pts to get this med as it reduces incidence of venospasm post-op which is a horrible complication of aneurysm clipping/coils
Rails - I'll bet you're talking about NIFEDIPINE!!! That comes in a coated tab.
Nimotop is an oily liquid that comes in a thick gelatine capsule. erezebet and I have given it to aneurism patients and it's an effective but very expensive drug that HAS to be given Q 4 hours - not Q3 hours and 30 minutes or Q3 hours and 45 minutes or 4 hours and 10 minutes....
I know that sometimes drug companies give the same meds different names in different countries, but I am pretty sure that we're talking about two different meds. They're both calcium channel blockers, though.
But I stand by my original statement that you should *Never* crush up enteric coated meds. Some of those enteric coatings are the time release factor. If you break up the enteric coating, then you release meds immediately that are supposed to be released gradually over time.
I am absolutely sure we are talking about Nimodipine.
This given in the neurovascular surgical unit I work for. These patients are head injury; SDH's; AVM's etc.
I have discussed this with Neurosurgical Registrar and no answer....
We give this QID post-operatively!!
But as I said we only have it in enteric coated tabs...and we give it crushed via NG!!!
Don't Crush that tablet!
Crushing enteric-coated tablets can jeopardize the drug's stability.
Crushing Sublingual tablets can make the drug unusable or ineffective.
Any drug formulation that claims to be extended release should not be crushed.
Consider compatibility of medications with enteral products before administering them together.
Some alternatives to crushing tablets or capsules include using a suppository or liquid formulation of the same medication, either commercially available or extemporaneously compounded. If the desired dosage formulation is not available from a pharmaceutical manufacturer and compounding is not feasible, recommend a therapeutic alternative that is available in an acceptable dosage formulation.
(Ref.: American Pharmacy. May '94 Vol. NS34, NO. 5. P.57-58)
I'd discuss this issue with the Pharmacy...
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?
"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! "
Uhhh what part of "NO" do your medics not understand? Ask these "medics" for the research that condones using this medication outside it's prescribed limitations. If you're unable to stand up to them yourself, tell your Supervisor, Manager, Pharmacy Manager... someone who will step up to the plate on this issue.
Particularly since you KNOW this not to be good nursing/medicine... your butt is in a sling if there is ever litigation because of this. It's your license, protect it.
i love this neuro stuff... no neuro unit where i work
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..........
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.
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