Nimodipine and SAH

Q: 44 years old female is admitted to neuro critical care after the diagnosis of subarachnoid hemorrhage (SAH). Nimodipine 60 mg every four hours is initiated. Nimodipine may cause blood pressure (BP) fluctuations and hypotension?

A) True

B) False

Answer: A

Although the mechanism of benefit of nimodipine in SAH is unknown but it is considered to be a standard of care. Studies have shown that the Odd Ratio (OR) of good outcome after SAH is 1.86. Ideally, it should be started within 48 hours of symptom onset. Only oral Nimodipine is recommended as intravenous (IV) Nimodipine may become fatal. Nimodipine should be continue for consecutive three weeks, as it reduces the deficit, mortality, and delayed cerebral ischemia.

Nimodipine works via several mechanisms such as dilation of small arteries (may not be visible on angiogram), reduction of calcium-dependent excitotoxicity, diminished platelet aggregation, and inhibition of ischemia triggered by red blood cell products.

Said all of the above, Nimodipine tends to cause BP fluctuations and hypotension after administration and should be watched for and managed accordingly.

#neuro-critical-care

#pharmacology

References:

1. Treggiari MM, Rabinstein AA, Busl KM, et al. Guidelines for the Neurocritical Care Management of Aneurysmal Subarachnoid Hemorrhage. Neurocrit Care 2023.

2. Pickard JD, Murray GD, Illingworth R, et al. Effect of oral nimodipine on cerebral infarction and outcome after subarachnoid haemorrhage: British aneurysm nimodipine trial. BMJ 1989; 298:636.

3. Dayyani M, Sadeghirad B, Grotta JC, et al. Prophylactic Therapies for Morbidity and Mortality After Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Network Meta-Analysis of Randomized Trials. Stroke 2022; 53:1993.

4. Dorhout Mees SM, Rinkel GJ, Feigin VL, et al. Calcium antagonists for aneurysmal subarachnoid haemorrhage. Cochrane Database Syst Rev 2007; :CD000277.