gms | German Medical Science

63rd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Japanese Neurosurgical Society (JNS)

German Society of Neurosurgery (DGNC)

13 - 16 June 2012, Leipzig

Serum levels of nimodipine in enteral and parenteral administration in patients with aneurismal subarachnoid hemorrhage – a therapy evaluation

Meeting Abstract

  • T. Abboud - Neurochirurgische Klinik, Universitätsklinikum Hamburg-Eppendorf
  • H. Andresen - Institut für Rechtsmedizin, Universitätsklinikum Hamburg-Eppendorf
  • J. Köppen - Neurochirurgische Klinik, Universitätsklinikum Hamburg-Eppendorf
  • M. Westphal - Neurochirurgische Klinik, Universitätsklinikum Hamburg-Eppendorf
  • J. Regelsberger - Neurochirurgische Klinik, Universitätsklinikum Hamburg-Eppendorf

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS). Leipzig, 13.-16.06.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocFR.08.06

DOI: 10.3205/12dgnc231, URN: urn:nbn:de:0183-12dgnc2314

Published: June 4, 2012

© 2012 Abboud et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

Text

Objective: The Cochrane review for aneurismal subarachnoid hemorrhage (SAH) found that oral nimodipine reduces the occurrence of secondary ischemia significantly; results for i.v. administration of nimodipine were not statistically significant. Soppi v. et al. found rate and extent of nimodipine absorption following enteral administration in the first three days after SAH to be negligible in 5 of 8 patients. Our therapy evaluation focussed on nimodipine serum levels during a two week course in which i.v. administration was switched to oral nimodipine on day 8 after SAH.

Methods: SAH patients were treated with nimodipine as continuous i.v. infusion of 2 mg/h for 7 days after initial hemorrhage, at day 8 we started enteral administration of 60 mg orally or via a nasogastric tube at 4 h intervals. Serum nimodipine concentrations (SNC) were measured at day 3, 5, and 8 once daily with a validated method by gas chromatography/electron capture detection. At day 9 and 12, blood samples were taken 4 times daily. We analyzed data of 15 patients (mean age 61y, 1 patient with SAH H&H grade I, 3 patients grade II, 4 patients grade III, 3 patients grade IV and 4 patients grade V). We collected a total of 157 blood samples (BS), 45 during parenteral therapy and 112 during enteral therapy. 48 BS were taken from patients with oral administration, 64 BS from patients with nasogastric tube.

Results: SNC during enteral administration (median 12 ng/ml) were significantly lower than during parenteral administration (median 30 ng/ml) P < 0.001. In 7 BS during enteral therapy (at day 9 & 12) of 2 patients (grade IV and V) SNC were under the detection limit of 3,6 ng/ml. In enteral therapy, SCN in patients grade I to III were significantly higher (median 13.8 ng/ml) than in patients grade IV and V (median 10 ng/ml) P = 0.035. However, during i.v. administration, no significant difference was detected between patients grade I to III (median 31 ng/ml) and patients grade IV and V (median 32 ng/ml) P = 0.593. SNC were found to be significantly higher during oral application (median 17.65 ng/ml) than under administration by gavage (median 9.4 ng/ml) P = < 0.001.

Conclusions: In patients with SAH IV and V enteral application of nimodipine may result in negligible serum levels up to day 12 after hemorrhage. We conclude that in patients in good clinical condition who allow for oral administration of nimodipine sufficient serum levels can be expected.