Nimodipine is a dihydropyridine calcium channel blocker that was originally developed for the treatment of high blood pressure. Post stroke cerebral vasospasm is now the main indication for Nimodipine usage with dosages used of up to 540mg per day. It is also sometimes used to improve cognitive function in dementia patients and to lessen the pain associated with cancer.
Nimodipine’s possible symptom effects on ME patients
Nimodipine’s primary usage in ME patients is to improve blood flow in the brain.
Nimodipine may secondarily:
- Increase energy levels
- Increase exercise tolerance
- Improve mental clarity
- Improve orthostatic hypotension
- Improve migraines
Dr. Goldstein performed a study to compare the SPECT scans of CFS patients prior to and post Nimodipine treatment. He found Nimodipine improved patients’ SPECT scans.
Verapamil, another channel blocker that works through an alternate method to Nimodipine, was studied in 25 CFS patients. It improved the patients’ immune systems and memory while reducing fatigue and pain.
ME/CFS Specialists’ opinions on Nimodipine
The Canadian ME/CFS Guidelines suggests the use of Nimodipine as it acts “primarily on the cerebral circulation. Improves mental clarity in some but not all patients with ME, but may also have a global effect to increase relaxation, reduce fatigue, decrease tender points, and improve exercise tolerance. Common side-effects include hypotension, nausea, headache, bradycardia, skin rash, and peripheral edema. Start with 30 mg. Check effect on blood pressure. Gradually increase to 60 mg twice a day as tolerated.”
Dr. Mason Brown has seen many of his ME/CFS patients improve with Nimodipine usage. He writes, “Nimodipine helps twenty per cent (of ME/CFS patients) very quickly, another twenty per cent over six months, and all others to varying degrees over a period of time.” He improved his own health to 95% with Nimodipine usage as a treatment for his ME/CFS. He states “The work of nimodipine is at least fourfold: to release the backlog of neurotoxins and waste products from the brain, to open up the brain circulation, to allow in oxygen and nutrients to enter and to help cognitions, pineal, hypothalamic, and pituitary function.”
Dr. J. Goldstein, now retired, specialized in the treatment of ME patients in California. He used Nimodipine as a primary treatment for M.E. and has called it “one of the most useful treatments for ME/CFS and Fibromyalgia.” He also writes, “About 40% of CFS/FM patients taking nimodipine experience relaxation, increased energy, a decrease in tender point sensitivity, improved exercise tolerance, and enhanced mental clarity…. Nimodipine has been shown to release dopamine, serotonin, and acetylcholine…. Tolerance does not develop to the vasodiliatory effects of nimodipine, but sometimes does to its amelioration of CFS/FM symptoms.” He recommends taking 30mg to 60mg 3 times a day.
Dr. J. Teitlebaum suggests that CFS patients take 30 mg of Nimodipine 1 to 4 times a day.
A report of accounts of Nimodipine usage in 13 ME patients found four of them did not receive any benefit. The other nine all had improved mental clarity or general functioning; half of them achieved functioning of 50% to 100%.
The FDA has classified the side effects of Nimodipine based on doses every four hours, with each dose being 90mg (far higher than the recommended ME/CFS dose.) Based on this classification, less than 1% of the group experienced adverse effects. The most common side effects of oral Nimodipine are dizziness, light-headedness, flushing or swelling of the ankles/feet. Some patients with severe ME start with 1/16th of a tablet of Nimodipine to attempt to mitigate side effects. Grapefruit juice should not be consumed while taking Nimodipine as it may elevate blood levels of the drug.
Dr. Chaudhuri and Professor Behan from Glasgow found many of their ME patients on Nimodipine to experience hypotension. They concluded that it partially improved patients’ myalgia however the high incidence of hypotension caused them to cease using the drug.
Nimodipine is a prescription drug that is fairly expensive. It also has many drug interactions. A similar treatment to Nimodipine, that some patients may prefer for various reasons, is called ‘Nifedipine.’ Discuss the potential positives and negatives of Nimodipine with your doctor before taking it.