Nimodipine
| Evidence Level: L5 | Predicted Indications: 10 |
Table of Contents
Nimodipine: From Subarachnoid Hemorrhage to Homozygous Familial Hypercholesterolemia
One-Sentence Summary
Nimodipine is a calcium channel blocker originally used for aneurysmal subarachnoid hemorrhage. The TxGNN model predicts it may be effective for homozygous familial hypercholesterolemia, but no clinical trials and no publications currently support this prediction, so it is a computational prediction only.
Quick Overview
| Item | Content |
|---|---|
| Original Indication | Subarachnoid hemorrhage (acquired aneurysmal subarachnoid hemorrhage), based on the knowledge graph; the Singapore licence records contain no indication text |
| Predicted New Indication | Homozygous familial hypercholesterolemia |
| TxGNN Prediction Score | 99.29% |
| Evidence Level | L5 |
| Singapore Market Status | ✓ Marketed |
| Number of Registrations | 2 |
| Recommended Decision | Hold |
Why is This Prediction Reasonable?
Currently, detailed mechanism of action data is not available. Based on known information, nimodipine is an L-type calcium channel blocker with selectivity for cerebral blood vessels. Its efficacy in subarachnoid hemorrhage (preventing vasospasm and delayed cerebral ischemia) is established.
For homozygous familial hypercholesterolemia, the data compiled for this report identify no plausible mechanistic link. The condition is caused by defects in LDL receptor pathways, and calcium channel blockade has no established role in lipid metabolism. The high TxGNN score is therefore best treated as a model output that needs independent validation rather than as supporting evidence.
Other top-ranked predictions show a similar pattern. Most also have no trials or literature. Two are somewhat more plausible mechanistically, congestive heart failure (indirect cardiovascular literature, but calcium channel blockers are generally not beneficial in heart failure with reduced ejection fraction) and Moyamoya angiopathy (cerebrovascular rationale, with a caution that lowering blood pressure could reduce cerebral perfusion). Neither has direct clinical evidence.
Clinical Trial Evidence
Currently no related clinical trials registered.
Literature Evidence
Currently no related literature available for homozygous familial hypercholesterolemia.
Singapore Market Information
| Authorization Number | Product Name | Dosage Form | Approved Indication |
|---|---|---|---|
| SIN06931P | NIMOTOP FOR INFUSION 0.02% | Injection | Not stated in the available record |
| SIN09111P | NIMOTOP TABLET 30 mg | Film-coated tablet | Not stated in the available record |
Both are valid single-ingredient products (manufacturer: Bayer AG). Routes available: injectable and oral.
Safety Considerations
- Disease contraindications (knowledge graph, not label text): liver disease, gallbladder disease, hypotensive disorder.
- Drug Interactions: 100 interactions were identified in total. Major-level interactions in the listed sample include clarithromycin and dolasetron. Moderate-level interactions include bupropion, aprepitant, morphine, acetylsalicylic acid, cimetidine, miconazole, magnesium sulfate, canagliflozin, dapagliflozin, empagliflozin, aminoglycosides (kanamycin, neomycin), and several calcium salts.
- Literature in the data also notes that grapefruit juice can raise the oral bioavailability of dihydropyridine calcium channel blockers through CYP3A4 inhibition.
Please refer to the package insert for warnings and label contraindications, which were not available for this report.
Conclusion and Next Steps
Decision: Hold
Rationale: The prediction rests on a model score alone (Evidence Level L5). There are no trials or publications, and no plausible mechanistic link between L-type calcium channel blockade and the LDL receptor pathway. Nimodipine is marketed in Singapore, but its safety profile in a lipid-disorder population has not been examined.
To proceed, the following is needed:
- Package insert warnings and contraindications from HSA (currently a blocking gap for safety screening)
- Mechanism of action data (e.g., from DrugBank)
- Preclinical or mechanistic evidence linking calcium channel blockade to lipid metabolism or LDL receptor function
- If pursuing other predictions, consider prioritising Moyamoya angiopathy as a research question, given its cerebrovascular rationale. This would still require a literature search and a hemodynamic safety assessment.
Disclaimer
This content is for research purposes only and does not constitute medical advice. Clinical validation is required before any clinical application.