Journal article
Comparison of nimodipine formulations and administration techniques via enteral feeding tubes in patients with aneurysmal subarachnoid hemorrhage: A multicenter retrospective cohort study
Pharmacotherapy, v 43(4), pp 279-290
Apr 2023
PMID: 36880540
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Background
Nimodipine improves outcomes following aneurysmal subarachnoid hemorrhage (aSAH) and current guidelines suggest that patients with aSAH receive nimodipine for 21 days. Patients with no difficulty swallowing will swallow the whole capsules or tablets; otherwise, nimodipine liquid must be drawn from capsules, tablets need to be crushed, or the commercially available liquid product be used to facilitate administration through an enteral feeding tube (FT). It is not clear whether these techniques are equivalent. The goal of the study was to determine if different nimodipine formulations and administration techniques were associated with the safety and effectiveness of nimodipine in aSAH.
Methods
This was a retrospective multicenter observational cohort study conducted in 21 hospitals across North America. Patients admitted with aSAH and received nimodipine by FT for ≥3 days were included. Patient demographics, disease severity, nimodipine administration, and study outcomes were collected. Safety end points included the prevalence of diarrhea and nimodipine dose reduction or discontinuation secondary to blood pressure reduction. Predictors of the study outcomes were analyzed using regression modeling.
Results
A total of 727 patients were included. Administration of nimodipine liquid product was independently associated with higher prevalence of diarrhea compared to other administration techniques/formulations (Odds ratio [OR] 2.28, 95% confidence interval [CI] 1.41–3.67, p‐value = 0.001, OR 2.76, 95% CI 1.37–5.55, p‐value = 0.005, for old and new commercially available formulations, respectively). Bedside withdrawal of liquid from nimodipine capsules prior to administration was significantly associated with higher prevalence of nimodipine dose reduction or discontinuation secondary to hypotension (OR 2.82, 95% CI 1.57–5.06, p‐value = 0.001). Tablet crushing and bedside withdrawal of liquid from capsules prior to administration were associated with increased odds of delayed cerebral ischemia (OR 6.66, 95% CI 3.48–12.74, p‐value <0.0001 and OR 3.92, 95% CI 2.05–7.52, p‐value <0.0001, respectively).
Conclusions
Our findings suggest that enteral nimodipine formulations and administration techniques might not be equivalent. This could be attributed to excipient differences, inconsistency and inaccuracy in medication administration, and altered nimodipine bioavailability. Further studies are needed.
Metrics
Details
- Title
- Comparison of nimodipine formulations and administration techniques via enteral feeding tubes in patients with aneurysmal subarachnoid hemorrhage: A multicenter retrospective cohort study
- Creators
- Sherif Hanafy Mahmoud - University of AlbertaFatma R. Hefny - University of AlbertaNicholas G. Panos - Rush University Medical CenterLaura Delucilla - McGill University Health CentreZinquon Ngan - McGill University Health CentreMarc M. Perreault - McGill University Health CentreLeslie A. Hamilton - University of Tennessee at KnoxvilleA. Shaun Rowe - University of Tennessee at KnoxvillePamela L. Buschur - Riverside Methodist HospitalJocelyn Owusu-Guha - Riverside Methodist HospitalSulaiman Almohaish - Virginia Commonwealth UniversityMelissa Sandler - Virginia Commonwealth UniversityMichael J. Armahizer - University of Maryland, BaltimoreMegan E. Barra - Massachusetts General HospitalAaron M. Cook - University of Kentucky HealthCareColleen A. Barthol - University HealthTrager D. Hintze - Texas CollegeAnna Cantin - Hartford HospitalJessica Traeger - University Hospitals of ClevelandJoseph R. Blunck - Saint Luke's HospitalJustin Shewmaker - Saint Luke's HospitalSarah V. Burgess - Queen Elizabeth II Health Sciences CentreKristin Kaupp - Queen Elizabeth II Health Sciences CentreCaitlin S. Brown - Mayo ClinicSarah L. Clark - Mayo ClinicErin D. Wieruszewski - Mayo ClinicEljim P. Tesoro - University of Illinois at ChicagoAbdalla A. Ammar - Yale New Haven HospitalMahmoud A. Ammar - Yale New Haven HospitalMandy J. Binning - Neurosciences InstituteStanislav Naydin - Neurosciences InstituteNeal Fox - Miami Valley HospitalDavid M. Peters - Cedarville UniversityLeana N. Mahmoud - LifespanShaun P. Keegan - University of CincinnatiGretchen M. Brophy - Virginia Commonwealth University
- Publication Details
- Pharmacotherapy, v 43(4), pp 279-290
- Publisher
- Wiley
- Number of pages
- 12
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Neurology
- Web of Science ID
- WOS:000952795600001
- Scopus ID
- 2-s2.0-85150789806
- Other Identifier
- 991021918000404721
UN Sustainable Development Goals (SDGs)
This publication has contributed to the advancement of the following goals:
InCites Highlights
Data related to this publication, from InCites Benchmarking & Analytics tool:
- Collaboration types
- Domestic collaboration
- International collaboration
- Web of Science research areas
- Pharmacology & Pharmacy