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Nimodipine for Subarachnoid Hemorrhage

Summary:

  • Recommendation:  For patients presenting with aneurysmal subarachnoid hemorrhage (aSAH), nimodipine 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 nimodipine 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 nimodipine.

Editors: 

  • Anthony J. Busti, MD, PharmD, FNLA, FAHA
  • DylanKellogg, MD

Last Updated:  August 2015

Supporting Guidelines

  • "Oral nimodipine should be administered to all patients with aSAH.  (It should be noted that this agent has been shown to improve neuro-logical outcomes, but not cerebral vasospasm. The value of other calcium antagonists, whether administered orally or intravenously, remains uncertain.)"

    • Guideline Rating: Class I; Level of Evidence A
    • Reference: Connolly ES et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2012;43(6):1711-37.  PubMed

Landmark or Original Studies

  • Pickard JD et al. Effect of oral nimodipine on cerebral infarction and outcome after subarachnoid haemorrhage: British aneurysm nimodipine trial. BMJ 1989;298(6674):636-42. PubMed
  • Allen GS et al. Cerebral arterial spasm - a controlled trial of nimodipine in patients with subarachnoid hemorrhage. N Engl J Med 1983;308(11):619-24. PubMed

Supporting Studies

  • Barker FG 2nd et al. Efficacy of prophylactic nimodipine for delayed ischemic deficit after subarachnoid hemorrhage: a metaanalysis. J Neurosurg 1996;84(3):405-14. PubMed
  • Dorhout Mees SM et al. Calcium antagonists for aneurysmal subarachnoid hemorrhage. Cochrane Database Syst Rev 2007;3:CD000277. PubMed

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