Safety and Clinical Effects of Switching From Intravenous to Oral Nimodipine Administration in Aneurysmal Subarachnoid Hemorrhage

Objective: Several guidelines recommend oral administration of nimodipine as vasospasm prophylaxis after aneurysmal subarachnoid hemorrhage (SAH). However, in clinical practice, the drug is administered orally and intravenously (i.v.), depending on clinical conditions and local treatment regimens. W...

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Autores principales:	Jennifer Göttsche, Nils Schweingruber, Julian Christopher Groth, Christian Gerloff, Manfred Westphal, Patrick Czorlich
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	subarachnoid hemorrhage Transcranial Doppler delayed cerebral ischemia vasospasm nimodipine norepinephrine Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/a0abcd15fffd4500a8001d9515d1dcb9
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spelling	oai:doaj.org-article:a0abcd15fffd4500a8001d9515d1dcb92021-11-16T06:11:40ZSafety and Clinical Effects of Switching From Intravenous to Oral Nimodipine Administration in Aneurysmal Subarachnoid Hemorrhage1664-229510.3389/fneur.2021.748413https://doaj.org/article/a0abcd15fffd4500a8001d9515d1dcb92021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fneur.2021.748413/fullhttps://doaj.org/toc/1664-2295Objective: Several guidelines recommend oral administration of nimodipine as vasospasm prophylaxis after aneurysmal subarachnoid hemorrhage (SAH). However, in clinical practice, the drug is administered orally and intravenously (i.v.), depending on clinical conditions and local treatment regimens. We have therefore investigated the safety and clinical effects of switching from i.v. to oral nimodipine therapy.Methods: Patients with aneurysmal SAH between January 2014 and April 2018 and initial i.v. nimodipine therapy, which was subsequently switched to oral administration, were included in this retrospective study. Transcranial Doppler sonography (TCD) of the vessels of the anterior circulation was performed daily. The occurrence of vasospasm and infarction during the overall course of the treatment was recorded. Statistical level of significance was set to p < 0.05.Results: A total of 133 patients (mean age 55.8 years, 65% female) initially received nimodipine i.v. after aneurysmal SAH, which was subsequently switched to oral administration after a mean of 12 days. There were no significant increases in mean flow velocities on TCD after the switch from i.v. to oral nimodipine administration regarding the anterior cerebral artery. For the middle cerebral artery, an increase from 62.36 to 71.78 cm/sec could only be detected in the subgroup of patients with infarction. There was no clustering of complicating events such as new-onset vasospasm or infarction during or after the switch.Conclusions: Our results do not point to any safety concerns when switching nimodipine from initial i.v. to oral administration. Switching was neither associated with clinically relevant increases in TCD velocities nor other relevant adverse events.Jennifer GöttscheNils SchweingruberJulian Christopher GrothChristian GerloffManfred WestphalPatrick CzorlichFrontiers Media S.A.articlesubarachnoid hemorrhageTranscranial Dopplerdelayed cerebral ischemiavasospasmnimodipinenorepinephrineNeurology. Diseases of the nervous systemRC346-429ENFrontiers in Neurology, Vol 12 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	subarachnoid hemorrhage Transcranial Doppler delayed cerebral ischemia vasospasm nimodipine norepinephrine Neurology. Diseases of the nervous system RC346-429
spellingShingle	subarachnoid hemorrhage Transcranial Doppler delayed cerebral ischemia vasospasm nimodipine norepinephrine Neurology. Diseases of the nervous system RC346-429 Jennifer Göttsche Nils Schweingruber Julian Christopher Groth Christian Gerloff Manfred Westphal Patrick Czorlich Safety and Clinical Effects of Switching From Intravenous to Oral Nimodipine Administration in Aneurysmal Subarachnoid Hemorrhage
description	Objective: Several guidelines recommend oral administration of nimodipine as vasospasm prophylaxis after aneurysmal subarachnoid hemorrhage (SAH). However, in clinical practice, the drug is administered orally and intravenously (i.v.), depending on clinical conditions and local treatment regimens. We have therefore investigated the safety and clinical effects of switching from i.v. to oral nimodipine therapy.Methods: Patients with aneurysmal SAH between January 2014 and April 2018 and initial i.v. nimodipine therapy, which was subsequently switched to oral administration, were included in this retrospective study. Transcranial Doppler sonography (TCD) of the vessels of the anterior circulation was performed daily. The occurrence of vasospasm and infarction during the overall course of the treatment was recorded. Statistical level of significance was set to p < 0.05.Results: A total of 133 patients (mean age 55.8 years, 65% female) initially received nimodipine i.v. after aneurysmal SAH, which was subsequently switched to oral administration after a mean of 12 days. There were no significant increases in mean flow velocities on TCD after the switch from i.v. to oral nimodipine administration regarding the anterior cerebral artery. For the middle cerebral artery, an increase from 62.36 to 71.78 cm/sec could only be detected in the subgroup of patients with infarction. There was no clustering of complicating events such as new-onset vasospasm or infarction during or after the switch.Conclusions: Our results do not point to any safety concerns when switching nimodipine from initial i.v. to oral administration. Switching was neither associated with clinically relevant increases in TCD velocities nor other relevant adverse events.
format	article
author	Jennifer Göttsche Nils Schweingruber Julian Christopher Groth Christian Gerloff Manfred Westphal Patrick Czorlich
author_facet	Jennifer Göttsche Nils Schweingruber Julian Christopher Groth Christian Gerloff Manfred Westphal Patrick Czorlich
author_sort	Jennifer Göttsche
title	Safety and Clinical Effects of Switching From Intravenous to Oral Nimodipine Administration in Aneurysmal Subarachnoid Hemorrhage
title_short	Safety and Clinical Effects of Switching From Intravenous to Oral Nimodipine Administration in Aneurysmal Subarachnoid Hemorrhage
title_full	Safety and Clinical Effects of Switching From Intravenous to Oral Nimodipine Administration in Aneurysmal Subarachnoid Hemorrhage
title_fullStr	Safety and Clinical Effects of Switching From Intravenous to Oral Nimodipine Administration in Aneurysmal Subarachnoid Hemorrhage
title_full_unstemmed	Safety and Clinical Effects of Switching From Intravenous to Oral Nimodipine Administration in Aneurysmal Subarachnoid Hemorrhage
title_sort	safety and clinical effects of switching from intravenous to oral nimodipine administration in aneurysmal subarachnoid hemorrhage
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/a0abcd15fffd4500a8001d9515d1dcb9
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Safety and Clinical Effects of Switching From Intravenous to Oral Nimodipine Administration in Aneurysmal Subarachnoid Hemorrhage

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