Components:
Nimodipine
Nimodipine
Method of action:
Arteriodilating, Neuroprotective, Nootropic, Vasodilator
Arteriodilating, Neuroprotective, Nootropic, Vasodilator
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Name of the medicinal product

AC Vascular

Qualitative and quantitative composition

Nimodipine

Therapeutic indications

The information provided in Therapeutic indications of AC Vascular is based on data of another medicine with exactly the same composition as the AC Vascular of the medicine (Nimodipine). Be careful and be sure to specify the information on the section Therapeutic indications in the instructions to the drug AC Vascular directly from the package or from the pharmacist at the pharmacy.
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Nimodipine is indicated for the treatment of ischaemic neurological deficits following aneurysmal subarachnoid haemorrhage.

Dosage (Posology) and method of administration

The information provided in Dosage (Posology) and method of administration of AC Vascular is based on data of another medicine with exactly the same composition as the AC Vascular of the medicine (Nimodipine). Be careful and be sure to specify the information on the section Dosage (Posology) and method of administration in the instructions to the drug AC Vascular directly from the package or from the pharmacist at the pharmacy.
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Posology

Recommended dose - Aneurysmal Subarachnoid Haemorrhage

For the first two hours of treatment 1 mg of nimodipine, i.e. 5 ml AC Vascular solution, (about 15 μg/kg bw/h), should be infused each hour via a central catheter. If it is well tolerated, the dose should be increased after two hours to 2 mg nimodipine, i.e. 10 ml AC Vascular solution per hour (about 30 μg/kg bw/h), providing no severe decrease in blood pressure is observed.

Patients of body weight less than 70 kg or with unstable blood pressure should be started on a dose of 0.5 mg nimodipine per hour (2.5 ml of AC Vascular solution), or less if necessary.

Duration of treatment

Aneurysmal subarachnoid haemorrhage

Intravenous treatment should begin as early as possible after neurological deficit occurs due to arterial spasm, post subarachnoid haemorrhage. This should continue for at least five days up to a maximum of 14 days.

In the event of surgical intervention during treatment, administration of nimodipine should be continued (dose as above) for at least five days.

AC Vascular solution may be used with or without pre-treatment with AC Vascular tablets. In the event of AC Vascular tablets and AC Vascular solution being administered sequentially the total duration of treatment should not exceed 21 days. AC Vascular solution should not be administered for longer than 14 days. AC Vascular solution and tablets should not be used concomitantly.

Traumatic subarachnoid haemorrhage

Not recommended as a positive benefit to risk ratio has not been established .

Paediatric Population

The safety and efficacy of AC Vascular in patients under 18 years of age have not been established.

Method of administration

AC Vascular solution is administered as a continuous I.V. infusion via a central catheter using an infusion pump. It should be connected to a three-way stopcock using the infusion line provided. The three-way stopcock should be used to connect the AC Vascular polyethylene tube with the co-infusion line and the central catheter. (The stopcock must allow for concomitant flow of the AC Vascular solution and a co-infusion solution.) AC Vascular solution must be administered with a co-infusion running at a rate of 40 ml/hr of either sodium chloride 0.9%, glucose 5%, Ringer's lactate solution, lactated Ringer's solution with magnesium, dextran 40, HAES® (poly[O-2-hydroxyethyl]) starch 6%, human albumin 5%, blood or mannitol 10% in a ratio of about 1:4 (AC Vascular:co-infusion), which is connected to the second port of the three-way stopcock prior to its connection with the central line catheter.

AC Vascular solution must not be added to an infusion bag or bottle and must not be mixed with other drugs.

AC Vascular solution may be used during anaesthesia, angiography or surgical procedures.

Contraindications

The information provided in Contraindications of AC Vascular is based on data of another medicine with exactly the same composition as the AC Vascular of the medicine (Nimodipine). Be careful and be sure to specify the information on the section Contraindications in the instructions to the drug AC Vascular directly from the package or from the pharmacist at the pharmacy.
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Nimodipine should not be administered to patients during or within one month of a myocardial infarction or an episode of unstable angina.

Special warnings and precautions for use

The information provided in Special warnings and precautions for use of AC Vascular is based on data of another medicine with exactly the same composition as the AC Vascular of the medicine (Nimodipine). Be careful and be sure to specify the information on the section Special warnings and precautions for use in the instructions to the drug AC Vascular directly from the package or from the pharmacist at the pharmacy.
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AC Vascular should not be used in patients with traumatic subarachnoid haemorrhage as a positive benefit to risk ratio has not been established and the specific patient groups that might benefit cannot be identified for this indication.

AC Vascular solution should be used with care when cerebral oedema or severely raised intracranial pressure are present. Although treatment with AC Vascular has not been shown to be associated with increases in intracranial pressure, close monitoring is recommended in these cases or when the water content of the brain tissue is elevated (generalised cerebral oedema).

AC Vascular solution must be used with caution in hypotensive patients (systolic blood pressure lower than 100 mm Hg).

Decreased drug clearance may occur in cirrhotic patients receiving AC Vascular and, therefore, close monitoring of blood pressure is recommended in these patients.

This medicinal product contains 1 mmol (23 mg) sodium per 50 ml bottle or 5.1 mmol (115 mg) sodium per 250 ml bottle. To be taken into consideration by patients on a controlled sodium diet.

Patients with known renal disease and/or receiving nephrotoxic drugs should have renal function monitored closely during intravenous treatment with AC Vascular solution .

Nimodipine is metabolised via the cytochrome P450 3A4 system. Drugs which are known inhibitors of the cytochrome P450 3A4 system and, therefore, may lead to increased plasma concentrations of nimodipine are macrolide antibiotics (e.g. erythromycin), anti-HIV protease inhibitors (e.g. ritonavir), azole antimycotics (e.g. ketoconazole), the antidepressants nefazodone and fluoxetine, quinupristin/dalfopristin, cimetidine and valproic acid .

Upon co-administration with these drugs, the blood pressure should be monitored and, if necessary, a reduction in the nimodipine dose should be considered.

This medicinal product contains 23.7 vol % ethanol (alcohol), i.e. up to 50 g per daily dose (250 ml). This may be harmful for those suffering from alcoholism or impaired alcohol metabolism and should be taken into account in pregnant or breast-feeding women, children and high-risk groups such as patients with liver disease or epilepsy. The amount of alcohol in this medicinal product may alter the effects of other medicines .

Effects on ability to drive and use machines

The information provided in Effects on ability to drive and use machines of AC Vascular is based on data of another medicine with exactly the same composition as the AC Vascular of the medicine (Nimodipine). Be careful and be sure to specify the information on the section Effects on ability to drive and use machines in the instructions to the drug AC Vascular directly from the package or from the pharmacist at the pharmacy.
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In theory, the possibility of the occurrence of the side-effect dizziness may impair the patient's ability to drive or operate machinery. However, this is unlikely to be of clinical relevance in patients receiving AC Vascular Solution.

Undesirable effects

The information provided in Undesirable effects of AC Vascular is based on data of another medicine with exactly the same composition as the AC Vascular of the medicine (Nimodipine). Be careful and be sure to specify the information on the section Undesirable effects in the instructions to the drug AC Vascular directly from the package or from the pharmacist at the pharmacy.
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The frequencies of ADRs reported with nimodipine summarized in the tables below are based on clinical trials with nimodipine in the indication aSAH sorted by CIOMS III categories of frequency (placebo-controlled studies: nimodipine N = 703; placebo N = 692; uncontrolled studies: nimodipine N = 2496; status: 31 Aug 2005). Within each frequency grouping, undesirable effects are presented in order of decreasing seriousness.

Frequencies are defined as:

Very common (≥ 1/10),

Common (≥ 1/100 to < 1/10),

Uncommon (≥ 1/1,000 to ≤ 1/100),

Rare (≥ 1/10,000 to ≤ 1/1,000),

Very rare (≤ 1/10,000)

System Organ Class

(MedDRA)

Uncommon

Rare

Blood and the lymphatic system disorders

Thrombocytopenia

Immune system disorders

Allergic reaction

Rash

Nervous system disorders

Headache

Cardiac disorders

Tachycardia

Bradycardia

Vascular disorders

Hypotension

Vasodilatation

Gastrointestinal disorders

Nausea

Ileus

Hepato-biliary disorders

Transient increase in liver enzymes

General disorders and administration site conditions

Injection and infusion site reactions

Infusion site (thrombo-) phlebitis

Reporting of suspected adverse reactions

Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via the Yellow Card Scheme at: www.mhra.gov.uk/yellowcard.

Overdose

The information provided in Overdose of AC Vascular is based on data of another medicine with exactly the same composition as the AC Vascular of the medicine (Nimodipine). Be careful and be sure to specify the information on the section Overdose in the instructions to the drug AC Vascular directly from the package or from the pharmacist at the pharmacy.
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Symptoms of intoxication

Symptoms of acute overdosage to be anticipated are marked lowering of the blood pressure, tachycardia, bradycardia and (after oral administration) gastro-intestinal complaints and nausea.

Treatment of intoxication

In the event of acute overdosage, treatment with AC Vascular must be discontinued immediately. Emergency measures should be governed by the symptoms. If the substance was ingested orally, gastric lavage with addition of charcoal should be considered as an emergency therapeutic measure. If there is a marked fall in blood pressure, dopamine or noradrenaline can be administered intravenously. As no specific antidote is known, subsequent treatment for other side effects should be aimed at the most prominent symptoms.

Pharmacodynamic properties

The information provided in Pharmacodynamic properties of AC Vascular is based on data of another medicine with exactly the same composition as the AC Vascular of the medicine (Nimodipine). Be careful and be sure to specify the information on the section Pharmacodynamic properties in the instructions to the drug AC Vascular directly from the package or from the pharmacist at the pharmacy.
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Pharmacotherapeutic group: selective calcium channel blockers with mainly vascular effect, dihydropyridine derivatives, ATC Code: C08CA06

Nimodipine is a dihydropyridine calcium channel blocker with particular cerebrovascular effect. Nimodipine increases cerebral perfusion, particularly in poorly perfused areas, by arterial dilatation, an effect which is proportionately greater in smaller than in larger vessels.

Vasoconstrictions provoked in vitro by various vasoactive substances (e.g., serotonin, prostaglandins and histamine) or by blood and blood degradation products can be prevented or reduced by up to 75 % by nimodipine.

Pharmacokinetic properties

The information provided in Pharmacokinetic properties of AC Vascular is based on data of another medicine with exactly the same composition as the AC Vascular of the medicine (Nimodipine). Be careful and be sure to specify the information on the section Pharmacokinetic properties in the instructions to the drug AC Vascular directly from the package or from the pharmacist at the pharmacy.
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The intravenous AC Vascular solution is 100% available to the tissues as the peripheral venous blood takes the drug to the lungs and heart and from there to all organs.

Absorption

After oral ingestion, absorption is rapid. Peak plasma concentrations are observed 30 to 60 minutes following oral administration. Despite high gastrointestinal absorption of nimodipine, the absolute bioavailability is 5 – 15 %, which is attributed to extensive first pass metabolism (about 85 – 95 %).

Distribution

The distribution volume (Vss, 2 compartment model) for i.v. administration is calculated to be 0.9 – 2.3 l/kg body weight. The total (systemic) clearance is 0.8 – 1.6 l/h/kg. Nimodipine is 97 – 99 % bound to plasma proteins.

Biotransformation

The cytochrome P450 3A4 system plays a major role in the metabolic elimination of nimodipine. Nimodipine is eliminated as metabolites, mainly by dehydrogenation of the dihydropyridine ring and oxidative O-demethylation. Oxidative ester cleavage, hydroxylation of the 2- and 6-methyl groups, and glucuronidation as a conjugation reaction are other important metabolic steps. The three primary metabolites occurring in plasma show no or only therapeutically negligible residual activity.

Elimination

Effects on liver enzymes by induction or inhibition are unknown. In humans the metabolites are excreted about 50 % renally and 30 % in the bile.

Linearity/non-linearity

For oral administration, the peak plasma concentration and the area under the curve increase proportionally to the dose up to the highest dose under test (90 mg). The elimination kinetics are linear. The half-life for nimodipine is between 1.1 and 1.7 hours. The terminal half-life is 5-10 hours, and is not relevant for establishing the recommended dosing interval for the medicinal product.

Pharmacotherapeutic group

The information provided in Pharmacotherapeutic group of AC Vascular is based on data of another medicine with exactly the same composition as the AC Vascular of the medicine (Nimodipine). Be careful and be sure to specify the information on the section Pharmacotherapeutic group in the instructions to the drug AC Vascular directly from the package or from the pharmacist at the pharmacy.
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selective calcium channel blockers with mainly vascular effect, dihydropyridine derivatives, ATC Code: C08CA06

Preclinical safety data

The information provided in Preclinical safety data of AC Vascular is based on data of another medicine with exactly the same composition as the AC Vascular of the medicine (Nimodipine). Be careful and be sure to specify the information on the section Preclinical safety data in the instructions to the drug AC Vascular directly from the package or from the pharmacist at the pharmacy.
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Non-clinical data reveal no special hazard for humans based on conventional studies of safety pharmacology, single and repeated dose toxicity, genotoxicity, carcinogenic potential, toxicity to reproduction. However, several preclinical findings may be of relevance to the prescribing physician. In chronic repeat dose toxicity studies in dogs, doses of 1 and 2.5 mg/kg/day were shown to be tolerated without adverse effect. However, at the higher dose of 6.25 mg/kg/day significant changes in ECGs were noted due to disturbances in myocardial blood flow, but there was no indication of histopathological damage to the heart. In pregnant rats, doses of 30 mg/kg/day and higher inhibited fetal growth and resulted in reduced fetal weights. At 100 mg/kg/day embryolethality occurred. No evidence of teratogenicity was observed. In rabbits, equivocal evidence of teratogenicity was seen in one study at doses up to 10 mg/kg/day. In two subsequent studies (one at 30 mg/kg/day), these findings were not reproduced. In one peri-postnatal study in rats, mortality and delayed physical development were observed at doses of 10 mg/kg/day and higher. The findings were not confirmed in subsequent studies.

Incompatibilities

The information provided in Incompatibilities of AC Vascular is based on data of another medicine with exactly the same composition as the AC Vascular of the medicine (Nimodipine). Be careful and be sure to specify the information on the section Incompatibilities in the instructions to the drug AC Vascular directly from the package or from the pharmacist at the pharmacy.
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AC Vascular solution reacts with polyvinylchloride (PVC) and should not be allowed to come in contact with PVC. AC Vascular solution must not be added to an infusion bag or bottle and must not be mixed with other drugs. Crystallization was observed during co-infusion of AC Vascular solution with 2.5% xylite in 0.4% sodium chloride solution (Summafusin), Aminosteril (Fresenius) and Ringer's solution DAB7.

Special precautions for disposal and other handling

The information provided in Special precautions for disposal and other handling of AC Vascular is based on data of another medicine with exactly the same composition as the AC Vascular of the medicine (Nimodipine). Be careful and be sure to specify the information on the section Special precautions for disposal and other handling in the instructions to the drug AC Vascular directly from the package or from the pharmacist at the pharmacy.
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The only plastic materials suitable for use are polyethylene or polypropylene. AC Vascular solution is compatible with glass infusion bottles and infusion packs made of polyethylene (e.g., Polyfusor, Boots).

The solution when in the syringe must be protected from direct sunlight during administration, but it is stable in diffuse daylight and artificial light for up to 10 hours. AC Vascular solution should be infused using a glass or rigid plastic (polyethylene or polypropylene) syringe and giving set (Gillette Sabre syringe; BD plastipak syringe; Monoject disposable syringe, Sherwood Medical Ltd; Combidyn tubes, Braun; Nitrocassette giving set, Imed Ltd.). AC Vascular solution is incompatible with infusion bags and any giving sets made of PVC (e.g., Viaflex, Travenol; Steriflex, Boots).

To penetrate the coated injection stoppers correctly, fine acute injection needles are recommended. DO NOT use large-core infusion needles, since this may result in cracked or bruised stoppers and the stoppers may be forced into the vial.

Name of the medicinal product
AC Vascular
Qualitative and quantitative composition
Nimodipine
Therapeutic indications
The information provided in Therapeutic indications of AC Vascular is based on data of another medicine with exactly the same composition as the AC Vascular of the medicine (Nimodipine). Be careful and be sure to specify the information on the section Therapeutic indications in the instructions to the drug AC Vascular directly from the package or from the pharmacist at the pharmacy.
more... close

Nimodipine is indicated for the treatment of ischaemic neurological deficits following aneurysmal subarachnoid haemorrhage.

Dosage (Posology) and method of administration
The information provided in Dosage (Posology) and method of administration of AC Vascular is based on data of another medicine with exactly the same composition as the AC Vascular of the medicine (Nimodipine). Be careful and be sure to specify the information on the section Dosage (Posology) and method of administration in the instructions to the drug AC Vascular directly from the package or from the pharmacist at the pharmacy.
more... close

Posology

Recommended dose - Aneurysmal Subarachnoid Haemorrhage

For the first two hours of treatment 1 mg of nimodipine, i.e. 5 ml AC Vascular solution, (about 15 μg/kg bw/h), should be infused each hour via a central catheter. If it is well tolerated, the dose should be increased after two hours to 2 mg nimodipine, i.e. 10 ml AC Vascular solution per hour (about 30 μg/kg bw/h), providing no severe decrease in blood pressure is observed.

Patients of body weight less than 70 kg or with unstable blood pressure should be started on a dose of 0.5 mg nimodipine per hour (2.5 ml of AC Vascular solution), or less if necessary.

Duration of treatment

Aneurysmal subarachnoid haemorrhage

Intravenous treatment should begin as early as possible after neurological deficit occurs due to arterial spasm, post subarachnoid haemorrhage. This should continue for at least five days up to a maximum of 14 days.

In the event of surgical intervention during treatment, administration of nimodipine should be continued (dose as above) for at least five days.

AC Vascular solution may be used with or without pre-treatment with AC Vascular tablets. In the event of AC Vascular tablets and AC Vascular solution being administered sequentially the total duration of treatment should not exceed 21 days. AC Vascular solution should not be administered for longer than 14 days. AC Vascular solution and tablets should not be used concomitantly.

Traumatic subarachnoid haemorrhage

Not recommended as a positive benefit to risk ratio has not been established .

Paediatric Population

The safety and efficacy of AC Vascular in patients under 18 years of age have not been established.

Method of administration

AC Vascular solution is administered as a continuous I.V. infusion via a central catheter using an infusion pump. It should be connected to a three-way stopcock using the infusion line provided. The three-way stopcock should be used to connect the AC Vascular polyethylene tube with the co-infusion line and the central catheter. (The stopcock must allow for concomitant flow of the AC Vascular solution and a co-infusion solution.) AC Vascular solution must be administered with a co-infusion running at a rate of 40 ml/hr of either sodium chloride 0.9%, glucose 5%, Ringer's lactate solution, lactated Ringer's solution with magnesium, dextran 40, HAES® (poly[O-2-hydroxyethyl]) starch 6%, human albumin 5%, blood or mannitol 10% in a ratio of about 1:4 (AC Vascular:co-infusion), which is connected to the second port of the three-way stopcock prior to its connection with the central line catheter.

AC Vascular solution must not be added to an infusion bag or bottle and must not be mixed with other drugs.

AC Vascular solution may be used during anaesthesia, angiography or surgical procedures.

Contraindications
The information provided in Contraindications of AC Vascular is based on data of another medicine with exactly the same composition as the AC Vascular of the medicine (Nimodipine). Be careful and be sure to specify the information on the section Contraindications in the instructions to the drug AC Vascular directly from the package or from the pharmacist at the pharmacy.
more... close
<

Nimodipine should not be administered to patients during or within one month of a myocardial infarction or an episode of unstable angina.

Special warnings and precautions for use
The information provided in Special warnings and precautions for use of AC Vascular is based on data of another medicine with exactly the same composition as the AC Vascular of the medicine (Nimodipine). Be careful and be sure to specify the information on the section Special warnings and precautions for use in the instructions to the drug AC Vascular directly from the package or from the pharmacist at the pharmacy.
more... close

AC Vascular should not be used in patients with traumatic subarachnoid haemorrhage as a positive benefit to risk ratio has not been established and the specific patient groups that might benefit cannot be identified for this indication.

AC Vascular solution should be used with care when cerebral oedema or severely raised intracranial pressure are present. Although treatment with AC Vascular has not been shown to be associated with increases in intracranial pressure, close monitoring is recommended in these cases or when the water content of the brain tissue is elevated (generalised cerebral oedema).

AC Vascular solution must be used with caution in hypotensive patients (systolic blood pressure lower than 100 mm Hg).

Decreased drug clearance may occur in cirrhotic patients receiving AC Vascular and, therefore, close monitoring of blood pressure is recommended in these patients.

This medicinal product contains 1 mmol (23 mg) sodium per 50 ml bottle or 5.1 mmol (115 mg) sodium per 250 ml bottle. To be taken into consideration by patients on a controlled sodium diet.

Patients with known renal disease and/or receiving nephrotoxic drugs should have renal function monitored closely during intravenous treatment with AC Vascular solution .

Nimodipine is metabolised via the cytochrome P450 3A4 system. Drugs which are known inhibitors of the cytochrome P450 3A4 system and, therefore, may lead to increased plasma concentrations of nimodipine are macrolide antibiotics (e.g. erythromycin), anti-HIV protease inhibitors (e.g. ritonavir), azole antimycotics (e.g. ketoconazole), the antidepressants nefazodone and fluoxetine, quinupristin/dalfopristin, cimetidine and valproic acid .

Upon co-administration with these drugs, the blood pressure should be monitored and, if necessary, a reduction in the nimodipine dose should be considered.

This medicinal product contains 23.7 vol % ethanol (alcohol), i.e. up to 50 g per daily dose (250 ml). This may be harmful for those suffering from alcoholism or impaired alcohol metabolism and should be taken into account in pregnant or breast-feeding women, children and high-risk groups such as patients with liver disease or epilepsy. The amount of alcohol in this medicinal product may alter the effects of other medicines .

Effects on ability to drive and use machines
The information provided in Effects on ability to drive and use machines of AC Vascular is based on data of another medicine with exactly the same composition as the AC Vascular of the medicine (Nimodipine). Be careful and be sure to specify the information on the section Effects on ability to drive and use machines in the instructions to the drug AC Vascular directly from the package or from the pharmacist at the pharmacy.
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In theory, the possibility of the occurrence of the side-effect dizziness may impair the patient's ability to drive or operate machinery. However, this is unlikely to be of clinical relevance in patients receiving AC Vascular Solution.

Undesirable effects
The information provided in Undesirable effects of AC Vascular is based on data of another medicine with exactly the same composition as the AC Vascular of the medicine (Nimodipine). Be careful and be sure to specify the information on the section Undesirable effects in the instructions to the drug AC Vascular directly from the package or from the pharmacist at the pharmacy.
more... close

The frequencies of ADRs reported with nimodipine summarized in the tables below are based on clinical trials with nimodipine in the indication aSAH sorted by CIOMS III categories of frequency (placebo-controlled studies: nimodipine N = 703; placebo N = 692; uncontrolled studies: nimodipine N = 2496; status: 31 Aug 2005). Within each frequency grouping, undesirable effects are presented in order of decreasing seriousness.

Frequencies are defined as:

Very common (≥ 1/10),

Common (≥ 1/100 to < 1/10),

Uncommon (≥ 1/1,000 to ≤ 1/100),

Rare (≥ 1/10,000 to ≤ 1/1,000),

Very rare (≤ 1/10,000)

System Organ Class

(MedDRA)

Uncommon

Rare

Blood and the lymphatic system disorders

Thrombocytopenia

Immune system disorders

Allergic reaction

Rash

Nervous system disorders

Headache

Cardiac disorders

Tachycardia

Bradycardia

Vascular disorders

Hypotension

Vasodilatation

Gastrointestinal disorders

Nausea

Ileus

Hepato-biliary disorders

Transient increase in liver enzymes

General disorders and administration site conditions

Injection and infusion site reactions

Infusion site (thrombo-) phlebitis

Reporting of suspected adverse reactions

Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via the Yellow Card Scheme at: www.mhra.gov.uk/yellowcard.

Overdose
The information provided in Overdose of AC Vascular is based on data of another medicine with exactly the same composition as the AC Vascular of the medicine (Nimodipine). Be careful and be sure to specify the information on the section Overdose in the instructions to the drug AC Vascular directly from the package or from the pharmacist at the pharmacy.
more... close

Symptoms of intoxication

Symptoms of acute overdosage to be anticipated are marked lowering of the blood pressure, tachycardia, bradycardia and (after oral administration) gastro-intestinal complaints and nausea.

Treatment of intoxication

In the event of acute overdosage, treatment with AC Vascular must be discontinued immediately. Emergency measures should be governed by the symptoms. If the substance was ingested orally, gastric lavage with addition of charcoal should be considered as an emergency therapeutic measure. If there is a marked fall in blood pressure, dopamine or noradrenaline can be administered intravenously. As no specific antidote is known, subsequent treatment for other side effects should be aimed at the most prominent symptoms.

Pharmacodynamic properties
The information provided in Pharmacodynamic properties of AC Vascular is based on data of another medicine with exactly the same composition as the AC Vascular of the medicine (Nimodipine). Be careful and be sure to specify the information on the section Pharmacodynamic properties in the instructions to the drug AC Vascular directly from the package or from the pharmacist at the pharmacy.
more... close

Pharmacotherapeutic group: selective calcium channel blockers with mainly vascular effect, dihydropyridine derivatives, ATC Code: C08CA06

Nimodipine is a dihydropyridine calcium channel blocker with particular cerebrovascular effect. Nimodipine increases cerebral perfusion, particularly in poorly perfused areas, by arterial dilatation, an effect which is proportionately greater in smaller than in larger vessels.

Vasoconstrictions provoked in vitro by various vasoactive substances (e.g., serotonin, prostaglandins and histamine) or by blood and blood degradation products can be prevented or reduced by up to 75 % by nimodipine.

Pharmacokinetic properties
The information provided in Pharmacokinetic properties of AC Vascular is based on data of another medicine with exactly the same composition as the AC Vascular of the medicine (Nimodipine). Be careful and be sure to specify the information on the section Pharmacokinetic properties in the instructions to the drug AC Vascular directly from the package or from the pharmacist at the pharmacy.
more... close

The intravenous AC Vascular solution is 100% available to the tissues as the peripheral venous blood takes the drug to the lungs and heart and from there to all organs.

Absorption

After oral ingestion, absorption is rapid. Peak plasma concentrations are observed 30 to 60 minutes following oral administration. Despite high gastrointestinal absorption of nimodipine, the absolute bioavailability is 5 – 15 %, which is attributed to extensive first pass metabolism (about 85 – 95 %).

Distribution

The distribution volume (Vss, 2 compartment model) for i.v. administration is calculated to be 0.9 – 2.3 l/kg body weight. The total (systemic) clearance is 0.8 – 1.6 l/h/kg. Nimodipine is 97 – 99 % bound to plasma proteins.

Biotransformation

The cytochrome P450 3A4 system plays a major role in the metabolic elimination of nimodipine. Nimodipine is eliminated as metabolites, mainly by dehydrogenation of the dihydropyridine ring and oxidative O-demethylation. Oxidative ester cleavage, hydroxylation of the 2- and 6-methyl groups, and glucuronidation as a conjugation reaction are other important metabolic steps. The three primary metabolites occurring in plasma show no or only therapeutically negligible residual activity.

Elimination

Effects on liver enzymes by induction or inhibition are unknown. In humans the metabolites are excreted about 50 % renally and 30 % in the bile.

Linearity/non-linearity

For oral administration, the peak plasma concentration and the area under the curve increase proportionally to the dose up to the highest dose under test (90 mg). The elimination kinetics are linear. The half-life for nimodipine is between 1.1 and 1.7 hours. The terminal half-life is 5-10 hours, and is not relevant for establishing the recommended dosing interval for the medicinal product.

Pharmacotherapeutic group
The information provided in Pharmacotherapeutic group of AC Vascular is based on data of another medicine with exactly the same composition as the AC Vascular of the medicine (Nimodipine). Be careful and be sure to specify the information on the section Pharmacotherapeutic group in the instructions to the drug AC Vascular directly from the package or from the pharmacist at the pharmacy.
more... close
selective calcium channel blockers with mainly vascular effect, dihydropyridine derivatives, ATC Code: C08CA06
Preclinical safety data
The information provided in Preclinical safety data of AC Vascular is based on data of another medicine with exactly the same composition as the AC Vascular of the medicine (Nimodipine). Be careful and be sure to specify the information on the section Preclinical safety data in the instructions to the drug AC Vascular directly from the package or from the pharmacist at the pharmacy.
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Non-clinical data reveal no special hazard for humans based on conventional studies of safety pharmacology, single and repeated dose toxicity, genotoxicity, carcinogenic potential, toxicity to reproduction. However, several preclinical findings may be of relevance to the prescribing physician. In chronic repeat dose toxicity studies in dogs, doses of 1 and 2.5 mg/kg/day were shown to be tolerated without adverse effect. However, at the higher dose of 6.25 mg/kg/day significant changes in ECGs were noted due to disturbances in myocardial blood flow, but there was no indication of histopathological damage to the heart. In pregnant rats, doses of 30 mg/kg/day and higher inhibited fetal growth and resulted in reduced fetal weights. At 100 mg/kg/day embryolethality occurred. No evidence of teratogenicity was observed. In rabbits, equivocal evidence of teratogenicity was seen in one study at doses up to 10 mg/kg/day. In two subsequent studies (one at 30 mg/kg/day), these findings were not reproduced. In one peri-postnatal study in rats, mortality and delayed physical development were observed at doses of 10 mg/kg/day and higher. The findings were not confirmed in subsequent studies.

Incompatibilities
The information provided in Incompatibilities of AC Vascular is based on data of another medicine with exactly the same composition as the AC Vascular of the medicine (Nimodipine). Be careful and be sure to specify the information on the section Incompatibilities in the instructions to the drug AC Vascular directly from the package or from the pharmacist at the pharmacy.
more... close

AC Vascular solution reacts with polyvinylchloride (PVC) and should not be allowed to come in contact with PVC. AC Vascular solution must not be added to an infusion bag or bottle and must not be mixed with other drugs. Crystallization was observed during co-infusion of AC Vascular solution with 2.5% xylite in 0.4% sodium chloride solution (Summafusin), Aminosteril (Fresenius) and Ringer's solution DAB7.

Special precautions for disposal and other handling
The information provided in Special precautions for disposal and other handling of AC Vascular is based on data of another medicine with exactly the same composition as the AC Vascular of the medicine (Nimodipine). Be careful and be sure to specify the information on the section Special precautions for disposal and other handling in the instructions to the drug AC Vascular directly from the package or from the pharmacist at the pharmacy.
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The only plastic materials suitable for use are polyethylene or polypropylene. AC Vascular solution is compatible with glass infusion bottles and infusion packs made of polyethylene (e.g., Polyfusor, Boots).

The solution when in the syringe must be protected from direct sunlight during administration, but it is stable in diffuse daylight and artificial light for up to 10 hours. AC Vascular solution should be infused using a glass or rigid plastic (polyethylene or polypropylene) syringe and giving set (Gillette Sabre syringe; BD plastipak syringe; Monoject disposable syringe, Sherwood Medical Ltd; Combidyn tubes, Braun; Nitrocassette giving set, Imed Ltd.). AC Vascular solution is incompatible with infusion bags and any giving sets made of PVC (e.g., Viaflex, Travenol; Steriflex, Boots).

To penetrate the coated injection stoppers correctly, fine acute injection needles are recommended. DO NOT use large-core infusion needles, since this may result in cracked or bruised stoppers and the stoppers may be forced into the vial.

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