Historical note and terminology
Nimodipine belongs to the class of pharmacological agents known as “calcium channel blockers” or “calcium antagonists.” These drugs have been used for several years in the treatment of cardiovascular disorders such as angina pectoris and hypertension. The success of calcium antagonists in cardiovascular disease encouraged research into their therapeutic potential in cerebrovascular conditions. The most extensively studied calcium channel blocker for stroke is nimodipine. Its efficacy in reducing infarct volume and improving outcome was demonstrated in animal models of focal ischemia, but subsequent clinical trials in stroke patients gave conflicting results.
Calcium antagonists were originally proposed for prevention or treatment of vasospasm following subarachnoid hemorrhage because of their ability to block the effect of a wide variety of vasoconstrictor substances on cerebral arteries in vitro. They were expected to prevent or ameliorate the narrowing of major arteries in the brain and to prevent ischemic brain damage. Nimodipine was the first well-known agent of this class for the treatment of subarachnoid hemorrhage and was found to be effective in reducing delayed ischemic effects when given within the first few hours of the ictus; its use for this indication is widely approved. Nimodipine is now considered to be a safe and well-documented drug for reduction in the severity of neurologic deficits resulting from vasospasm in subarachnoid hemorrhage (Tomassoni et al 2008). A survey in the United States has shown that over 90% of responding physicians administer nimodipine to all patients with nontraumatic subarachnoid hemorrhage (Tomycz et al 2011).
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