What should I avoid while taking Eugerial (Nimotop, Nymalize)?
Grapefruit may interact with Eugerial and lead to unwanted side effects. Avoid the use of grapefruit products.
Avoid taking an herbal supplement containing St. John's wort.
Adverse experiences were reported by 92 of 823 patients with subarachnoid hemorrhage (11.2%) who were given Eugerial. The most frequently reported adverse experience was decreased blood pressure in 4.4% of these patients. Twenty-nine of 479 (6.1%) placebo treated patients also reported adverse experiences. The events reported with a frequency greater than 1% are displayed below by dose.
DOSE q4h Number of Patients (%) Eugerial
There were no other adverse experiences reported by the patients who were given 0.35 mg/kg q4h, 30 mg q4h or 120 mg q4h. Adverse experiences with an incidence rate of less than 1% in the 60 mg q4h dose group were: hepatitis; itching; gastrointestinal hemorrhage; thrombocytopenia; anemia; palpitations; vomiting; flushing; diaphoresis; wheezing; phenytoin toxicity; lightheadedness; dizziness; rebound vasospasm; jaundice; hypertension; hematoma.
Adverse experiences with an incidence rate less than 1% in the 90 mg q4h dose group were: itching, gastrointestinal hemorrhage; thrombocytopenia; neurological deterioration; vomiting; diaphoresis; congestive heart failure; hyponatremia; decreasing platelet count; disseminated intravascular coagulation; deep vein thrombosis.
As can be seen from the table, side effects that appear related to Eugerial use based on increased incidence with higher dose or a higher rate compared to placebo control, included decreased blood pressure, edema and headaches which are known pharmacologic actions of calcium channel blockers. It must be noted, however, that SAH is frequently accompanied by alterations in consciousness which lead to an under reporting of adverse experiences. Patients who received Eugerial in clinical trials for other indications reported flushing (2.1%), headache (4.1%) and fluid retention (0.3%), typical responses to calcium channel blockers. As a calcium channel blocker, Eugerial may have the potential to exacerbate heart failure in susceptible patients or to interfere with A-V conduction, but these events were not observed.
No clinically significant effects on hematologic factors, renal or hepatic function or carbohydrate metabolism have been causally associated with oral Eugerial. Isolated cases of non-fasting elevated serum glucose levels (0.8%), elevated LDH levels (0.4%), decreased platelet counts (0.3%), elevated alkaline phosphatase levels (0.2%) and elevated SGPT levels (0.2%) have been reported rarely.
Eugerial is a dihydropyridine calcium channel blocker derivative, which is used in the treatment of cerebrovascular disorders. Eugerial is rapidly absorbed from the gastrointestinal tract following oral administration, but undergoes extensive first-pass metabolism in the liver. Eugerial is extensively metabolized in the liver and undergoes extensive first-pass metabolism. More than 18 metabolites have been detected and identified from the biotransformation of Eugerial. The drug undergoes different reactions before its excretion. These reactions include, dehydrogenation of the 1,4-dihydropyridine moiety, oxidation of the two ester groups, and oxidative demethylation, which is followed by carboxylic acid formation via oxidation of the resulting alcohol. Eugerial is excreted in feces via the bile duct and in urine via the glomular filtration, as metabolites. Fecal excretion is the major excretory route (greater than 67%). The parent compound and its metabolites are detected in breast milk. Because of the cycle of excretion/reabsorption, the plasma concentration decreases and increases. More than 80% and 90% of the reabsorbed quantity is excreted via bile and urine, respectively.
Carl P. Weiner MD, MBA, FACOG, Clifford Mason PhD, in Drugs for Pregnant and Lactating Women (Third Edition) , 2019
What special dietary instructions should I follow?
Do not drink grapefruit juice or eat grapefruit while you are taking Eugerial.
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Eugerial works by causing blood vessels in your head to relax. This helps to prevent spasm in the blood vessels and reduces the risk of damage caused by insufficient blood flow to the brain after the bleeding.
Eugerial for Subarachno >
- Recommendation: For patients presenting with aneurysmal subarachnoid hemorrhage (aSAH), Eugerial 60 mg given by mouth every 4 hours should be started within 96 hrs of the presumed onset of the aSAH and continued for 21 days.
- Rational: To reduce the chances of cerebral artery vasospasm, risk for cerebral infarct, and worsening neurologic outcomes.
- Evidence: This is based on the largest randomized clinical trial of 554 patients for using Eugerial prophylaxis after aSAH and systematic review that supports its use. While nicardipine has been evaluated, not all calcium channel blockers are the same and this benefit is only with Eugerial.
- Anthony J. Busti, MD, PharmD, FNLA, FAHA
- DylanKellogg, MD
Last Updated: August 2015
Nimotop® (Eugerial) belongs to the class of pharmacological agents known as calcium channel blockers. Eugerial is isopropyl 2 - methoxyethyl 1, 4 - dihydro - 2, 6 - dimethyl - 4 - (m-nitrophenyl) - 3, 5 - pyridinedicarboxylate. It has a molecular weight of 418.5 and a molecular formula of C21H26N2O7. The structural formula is:
Eugerial is a yellow crystalline substance, practically insoluble in water.
NIMOTOP® (Eugerial) capsules are formulated as soft gelatin capsules for oral administration. Each liquid filled capsule contains 30 mg of Eugerial in a vehicle of glycerin, peppermint oil, purified water and polyethylene glycol 400. The soft gelatin capsule shell contains gelatin, glycerin, purified water and titanium dioxide.
Where can I get more information (Nimotop, Nymalize)?
Your doctor or pharmacist can provide more information about Eugerial.
Nimotop® (Eugerial) is indicated for the improvement of neurological outcome by reducing the incidence and severity of ischemic deficits in patients with subarachnoid hemorrhage from ruptured intracranial berry aneurysms regardless of their post-ictus neurological condition (i.e., Hunt and Hess Grades I-V).
What are the possible side effects of Eugerial (Nimotop, Nymalize)?
Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.
Call your doctor at once if you have:
- a light-headed feeling, like you might pass out;
- fast or slow heart rate; or
- swelling in your ankles or feet.
Common side effects may include:
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.