Medication errors in the administration of nimodipine (Nimotop) continue to occur, despite a black-box warning that's been on the drug's labeling since 2006. Nimodipine comes in capsule form and is intended for oral administration, yet there have been 25 reports, dating from the initial marketing of the drug in 1989 to 2009, in which the drug was either prescribed to be given intravenously or was inadvertently administered intravenously.

Nimodipine is a calcium channel blocker approved for use to reduce the risk and severity of ischemic deficits after subarachnoid hemorrhage. IV administration of nimodipine can produce serious hypotension, bradycardia, cardiac arrest, and cardiovascular collapse (adverse effects that might be expected from an overdose of any calcium channel blocker); some deaths have occurred when nimodipine was administered intravascularly.

It might seem strange that a provider could mistakenly administer a drug intravenously or intravascularly when it comes in pill form, but the confusion arises when patients aren't able to swallow the pill and the dose must be withdrawn from the capsule using a needle and syringe. When the drug is withdrawn in this manner it must be administered through a nasogastric or gastrostomy tube, which is then flushed with normal saline; it should never be administered intravenously (nor should any oral capsule or liquid).

There are several techniques nurses can use to prevent this type of error. After withdrawing the nimodipine into a syringe, they can label the syringe "For oral use." They can also remove the needle from the syringe after withdrawing the drug from the capsule or squirt the liquid medication into an oral plastic medication cup. Such measures help to visually reinforce that the drug is for oral administration. Nurses who work in critical care areas where nimodipine is frequently administered are encouraged to develop work habits that will help to prevent this potentially lethal medication-administration error. To read the Food and Drug Administration Drug Safety Communication, go to http://bit.ly/9Wj3qt. The drug's labeling information can be found at http://bit.ly/bM21GQ.