Pharmacist Mayo Clinic Arizona Phoenix, Arizona, United States
Introduction: Nimodipine has demonstrated efficacy in improving outcomes in patients with aneurysmal subarachnoid hemorrhage (aSAH). However, hypotension and logistical factors limit adherence to the guideline recommended dosing regimen. Various studies have evaluated the efficacy of alternative dosing strategies compared with guideline recommend dosing on vasospasm, delayed cerebral ischemia, and functional outcomes, but studies comparing varied total daily cumulative doses and their impact on long term functional outcomes are lacking.
Methods: Patients admitted with aSAH to stroke centers within a multisite health system from January 2020 through May 2022 who received nimodipine were included. Patients who died or had withdrawal of life sustaining treatment within 24 hours of admission were excluded. Patient outcomes were classified as favorable if the patient had a modified Rankin Score (mRS) ≤ 2 or the patient returned to work at the time of the first follow-up visit. Univariate tests were conducted using the Wilcoxon rank-sum test or two-sample t-test for continuous variables and Chi-Squared Goodness-of-Fit test or Fisher’s Exact test for categorical variables. A multivariable logistic regression model was conducted with the aim of determining if the average cumulative daily dose of nimodipine is a significant predictor of outcome.
Results: A total of 112 patients were included, 64.3% of which had a favorable outcome. Patients with a favorable outcome were younger, had a lower admission Hunt and Hess score, and were less likely to experience a nimodipine dose interruption and regimen change. Patients with a favorable outcome had a significantly higher average inpatient cumulative daily dose of nimodipine (mean 349.0 vs. 316.1 mg, p = 0.008). After adjusting for age and Hunt and Hess score, the average cumulative daily dose of nimodipine remained a significant predictor of a favorable outcome. For an average daily cumulative dose increase of 30 mg of nimodipine, the odds of a favorable outcome increased by 32.7% (p = 0.018).
Conclusions: Higher average daily cumulative doses of nimodipine increase the odds of a favorable outcome. Prospective studies are needed to better assess the relationship between daily cumulative doses of nimodipine and outcomes in patients with aSAH.
