CLI N IC AL QU ER I ES
Using nimodipine for patients
with aneurysmal subarachnoid
hemorrhage
Can you explain why nimodipine is
used after aneurysmal subarachnoid
hemorrhage (aSAH)?—A.W., MO.
Wendi Rank, MSN, RN, CNRN,
CRNP, replies: In aSAH, a cerebral
aneurysm ruptures and blood col-
lects in the subarachnoid space.
Nimodipine, a calcium channel
blocker, decreases morbidity from
aSAH-related vasospasm, a compli-
cation that affects 30% to 70% of
patients with aSAH.1-3
Extravascular oxyhemoglobin, a
remnant of the subarachnoid hemor-
rhage (SAH), initiates physiologic
responses that cause vasospasm.3 For
some patients, vasospasm doesn’t
cause any adverse clinical events. For
others, cerebral ischemia and infarc-
tion are a direct complication, signifi-
cantly affecting patient outcomes.1,3
Although vasospasm can develop
at any time after the hemorrhage, the
peak incidence is 7 to 10 days after-
wards. Vasospasm resolves on its
own 21 days after aSAH.1,3
Nimodipine, the only FDA-
approved drug for treating vaso-
spasm due to aSAH in adults, is the
standard of care according to the
2012 American Stroke Association
guidelines on aSAH. Although ni-
modipine doesn’t relieve vasospasm,
neurologic function is better pre-
served in patients with aSAH who
receive nimodipine.3 How it decreas-
es morbidity isn’t well understood.
Patients should begin therapy with
nimodipine within 4 days of aSAH
and remain on the drug for 21 days.
The dosage should be reduced for
patients with hepatic impairment.4
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It’s available as an oral capsule and
as an oral solution.
Nimodipine should be used cau-
tiously in patients with increased
intracranial pressure because of its
hypotensive effects. Nimodipine can
decrease BP because of its calcium
channel-blocking properties, and
administering it with other anti-
hypertensives, including beta-blockers,
can increase this effect. The dosage
can be reduced if the patient devel-
ops significant hypotension.4
It’s important to remember that
patients receiving nimodipine con-
tinue to be at risk for vasospasm.
New or worsening neurologic defi-
cits may be signs of clinically signifi-
cant vasospasm. Altered level of con-
sciousness, particularly that which
repeatedly deteriorates and im-
proves, is a characteristic finding of
vasospasm that can be confirmed
with angiography.2 ■
REFERENCES
1. Barker E. Neuroscience Nursing: A Spectrum of
Care. 3rd ed. St. Louis, MO: Mosby Elsevier; 2008.
2. Bederson JB, Connolly ES Jr, Batjer HH, et al.
Guidelines for the management of aneurysmal
subarachnoid hemorrhage: a statement for health-
care professionals from a special writing group of
the Stroke Council, American Heart Association.
Stroke. 2009;40(3):994-1025.
3. Connolly ES Jr, Rabinstein AA, Carhuapoma JR,
et al. Guidelines for the management of aneurysmal
subarachnoid hemorrhage: a guideline for health-
care professionals from the American Heart
Association/American Stroke Association. Stroke.
2012;43(6):1711-1737.
4. Nimodipine. Prescribing information. 2008.
http://www.drugs.com/pro/nimodipine.html.
Wendi Rank is a board member of the Philadelphia
chapter of the American Association of Neuroscience
Nurses.
The author has disclosed that she has no financial
relationships related to this article.
DOI-10.1097/01.NURSE.0000438705.89850.21
January l Nursing2014 l 67