Importance of the Return of Nimodipine to Brazil: pharmacological options for cerebral vasospasm after subarachnoid hemorrhage. Literature review

Resumo

Introdução: Vasoespasmo cerebral refere-se ao estreitamento ou redução do diâmetro das artérias cerebrais ocorrendo pós manejo de hemorragia subaracnoidea aneurismática. Como consequência desse vasoespasmo, há isquemia cerebral tardia, que gera comprometimento neurológico. O uso de Nimodipino é o principal indicado com nível de evidência A e classe de recomendação 1, apresentando benefícios na prevenção e melhorando os resultados funcionais. Ademais, o Brasil não possui importação nem fabricação própria do nimodipino. Objetivo: Revisar a literatura de todos os medicamentos orais e endovenosos para prevenção de vasoespasmo cerebral pós-hemorragia subaracnoidea e apresentar a falta desse medicamento no Brasil. Resultados: O nimodipino demonstrou eficácia na redução do vasoespasmo cerebral pós-hemorragia subaracnoidea aneurismática, embora não tenha demonstrado redução significativa na mortalidade. Outros medicamentos, como milrinone, clazosentan, cilostazol e estatinas também apresentaram benefícios, mas sua eficácia e segurança podem variar dependendo das circunstâncias individuais do paciente. Conclusão: O nimodipino é o medicamento com melhor comprovação e não está presente no Brasil em nenhuma forma de administração e, portanto, medidas cabíveis devem ser tomadas.

Palavras-chave

Vasoespasmo intracraniano; Hemorragia subaracnoidea aneurismática; Nimodipino; Isquemia encefálica

Abstract

Introduction: Cerebral vasospasm refers to the narrowing or reduction in diameter of cerebral arteries occurring after management of aneurysmal subarachnoid hemorrhage. As a consequence of this vasospasm, there is delayed cerebral ischemia, which generates neurological impairment. The use of Nimodipine is the main indication with level of evidence A and class of recommendation 1, presenting benefits in prevention and improving functional results. Furthermore, Brazil does not import or manufacture nimodipine itself. Objective: To review the literature on all oral and intravenous medications for preventing cerebral vasospasm after subarachnoid hemorrhage and present the lack of this medication in Brazil. Results: Nimodipine demonstrated efficacy in reducing cerebral vasospasm after aneurysmal subarachnoid hemorrhage, although it did not demonstrate a significant reduction in mortality. Other medications, such as Milrinone, Clazosentan, Cilostazol, and Statins have also shown benefits, but their effectiveness and safety may vary depending on the patient’s individual circumstances. Conclusion: Nimodipine is the best proven medication and is not present in Brazil in any form of administration and, therefore, appropriate measures must be taken.

Keywords

Intracranial vasospasm; Aneurysmal subarachnoid hemorrhage; Nimodipine; Brain ischemia

References

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Importance of the Return of Nimodipine to Brazil: pharmacological options for cerebral vasospasm after subarachnoid hemorrhage. Literature review

Importância da Volta do Nimodipino para o Brasil: opções farmacológicas para tratamento do vasoespasmo cerebral pós-hemorragia subaracnoide. Revisão de literatura

Resumo

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References

JBNC Brazilian Journal of Neurosurgery

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