The Prognostic Significance of the Concentration of Nimodipine in the CSF and Plasma in Subarachnoid Hemorrhage

Abstract

A major cause of mortality and morbidity in subarachnoid hemorrhage of aneurysmal origin is vasospasm. An analysis of the available placebo-controlled double-blind and open prospective studies provides statistically significant evidence that the calcium antagonist nimodipine can reduce the frequency of these spasm-induced delayed ischemic neurological deficits. However, very divergent percentages are reported in the various studies, ranging in the randomized studies from 1% with intravenous administration to 2%–16% with oral dosage [1–6,8–11]. It is unclear what intraindividual and interindividual variations in the plasma and CSF concentration are present or are to be expected in medication with nimodipine. A high level of protein binding and the interaction with other drugs are known with regard to pharmacokinetics [12].