Effects of 14 Versus 21 Days of Nimodipine Therapy on Neurological Outcomes in Aneurysmal Subarachnoid Hemorrhage Patients.
Oral nimodipine is standard therapy for patients suffering an aneurysmal subarachnoid hemorrhage (aSAH). During a national drug shortage, nimodipine therapy was shortened from a 21-day course to a 14-day course at our institution.



The objective of this study was to compare neurological outcomes among patients who had previously received the standard duration of therapy compared with those who received a shortened duration as a result of the national drug shortage.



This retrospective cohort study evaluated adult patients receiving nimodipine for aSAH from January 2012 to August 2013. Neurological outcome, graded by Modified Rankin Scale (mRS) at hospital discharge, was compared between patients receiving a shortened course and those receiving the standard duration of nimodipine.



A total of 199 aSAH patients were included in the analysis. There were 164 patients in the standard-duration and 35 patients in the shortened-duration group. Baseline patient severity of illness, assessed by SAPS II (Simplified Acute Physiology Score), and severity of aSAH, assessed by Fisher grade, and Hunt and Hess grade scores, did not differ between the treatment groups. A shortened duration of nimodipine was not associated with a higher risk of a poor neurological outcome defined by mRS (odds ratio = 1.85; 95% CI = 0.54-6.32; P = 0.32). Mortality rates were similar between the groups.



A 14-day course of nimodipine therapy was not associated with worse neurological outcomes in aSAH patients at one institution. More studies are needed prior to recommending a shortened duration of nimodipine therapy in all aSAH patients.
University of Washington Medical Center, Seattle, WA, USA susancho@uw.edu.
Susan
S
Cho
University of Washington Medical Center, Seattle, WA, USA.
James
J
Bales
Harborview Medical Center, Seattle, WA, USA.
Thao Kim
TK
Tran
Harborview Medical Center, Seattle, WA, USA.
Gina
G
Korab
Harborview Medical Center, Seattle, WA, USA.
Nita
N
Khandelwal
Harborview Medical Center, Seattle, WA, USA.
Aaron M
AM
Joffe
D000328:Adult; D000368:Aged; D002121:Calcium Channel Blockers / Q000008:administration & dosage* / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D004363:Drug Utilization / Q000639:trends; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009553:Nimodipine / Q000008:administration & dosage* / Q000627:therapeutic use*; D016017:Odds Ratio; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000188:drug therapy* / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome
D002121:Calcium Channel Blockers; D009553:Nimodipine
calcium channel blockers; central nervous system; critical care; neurosurgery; stroke