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From: "Steven L. Dubovsky" <Steven.Dubovsky@UCHSC.edu>
Date: Sun, 18 Feb 1996 13:06:09 MST
Subject: Nimodipine
I often prescribe Ca channel blockers, with varying success, and have been intrigued by the reports about nimodipine as perhaps more helpful, especially in the depressed phase of rapid cycling. I went to prescribe it and discovered that it is priced at a retail cost of over $500 per month. In the meantime I've stuck with sustained-release nifedipine and verapamil.The only evidence that nimodipine is of any help in depression is a study by Pazzaglia et al using pts as their own controls that found both nimodipine and verapamil useful in one pt with recurrent brief depression. The other pts were quite complex and I don't think it is possible to say that nimodipine was superior to anything. There are only 2 other studies of nimodipine, and one was just a week long. This drug costs about $5 a pill (30 mg), and doses are 180-720 mg/day! The idea about differential efficacy is that there are different binding sites on the L channel for different ccb classes, so one might work where another doesn't, and that nimodipine has stronger anticonvulsant effects than verapamil.--Dave Kahn
I am aware of one study of diltiazem in mania and none of any other ccbs other than those mentioned here. If the sustained release form works for you, fine -- it worked for Paul Goodnick in 3 case reports he published. However, due to very extensive first pass metabolism, levels are often quite low with this form and many pts do better on the regular verapamil preparation.
I have seen medicaid and other insurers pay for nimodipine, and occasionally it has helped. Not great in my experience.
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