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Nimodipine-associated standard dose reductions and neurologic outcomes after aneurysmal subarachnoid hemorrhage: the era of pharmacogenomics
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Nimodipine-associated standard dose reductions and neurologic outcomes after aneurysmal subarachnoid hemorrhage: the era of pharmacogenomics
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Journal Article
Nimodipine-associated standard dose reductions and neurologic outcomes after aneurysmal subarachnoid hemorrhage: the era of pharmacogenomics
2024
Overview
Nimodipine, an L-type cerebroselective calcium channel antagonist, is the only drug approved by the US Food and Drug Administration for the neuroprotection of patients with aneurysmal subarachnoid hemorrhage (aSAH). Four randomized, placebo-controlled trials of nimodipine demonstrated clinical improvement over placebo; however, these occurred before precision medicine with pharmacogenomics was readily available. The standard enteral dose of nimodipine recommended after aSAH is 60 mg every 4 h. However, up to 78% of patients with aSAH develop systemic arterial hypotension after taking the drug at the recommended dose, which could theoretically limit its neuroprotective role and worsen cerebral perfusion pressure and cerebral blood flow, particularly when concomitant vasospasm is present. We investigated the association between nimodipine dose changes and clinical outcomes in a consecutive series of 150 patients (mean age, 56 years; 70.7% women) with acute aSAH. We describe the pharmacogenomic relationship of nimodipine dose reduction with clinical outcomes. These results have major implications for future individualized dosing of nimodipine in the era of precision medicine.
Publisher
Nature Publishing Group UK,Nature Publishing Group
Subject
/ 692/700
/ Adult
/ Aged
/ Aneurysm
/ Biomedical and Life Sciences
/ Calcium Channel Blockers - administration & dosage
/ Calcium Channel Blockers - adverse effects
/ Calcium Channel Blockers - therapeutic use
/ Dosage
/ Dose-Response Relationship, Drug
/ Female
/ Humans
/ Male
/ Nimodipine - administration & dosage
/ Nimodipine - adverse effects
/ Oncology
/ Placebos
/ Precision Medicine - methods
/ Stroke
/ Subarachnoid Hemorrhage - complications
/ Subarachnoid Hemorrhage - drug therapy
