Pharmacokinetics of nimodipine in multimorbid elderly patients with chronic brain failure

Eicher, H.; Hilgert, D.; Zeeh, Joachim; Platt, D.; Becker, Cord Michael; Mutschler, E.

doi:10.1016/0167-4943(92)90030-8

Cited by 6 publications

(3 citation statements)

References 17 publications

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“…This suggests that older adults have reduced first-pass metabolism of oral nimodipine compared with younger patients. Similar C max and AUC values have been reported in a study of 21 elderly patients with various central nervous system disorders [37]. In addition, in a population PK analysis of previous PK studies, the authors have found that nimodipine CL was reduced by 32% in elderly subjects (aged ≥ 65 years).…”

Section: Effect Of Age On Nimodipine Pharmacokineticssupporting

confidence: 81%

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Nimodipine Pharmacokinetic Variability in Various Patient Populations

Mahmoud

Isse

2020

Drugs R D

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Nimodipine has been shown to improve outcomes following aneurysmal subarachnoid hemorrhage. Guidelines recommend that all patients receive a fixed dose of oral nimodipine for 21 days. However, pharmacokinetic studies have suggested variability of nimodipine pharmacokinetics in subarachnoid hemorrhage and in other patient populations. The clinical relevance of such variability is unknown. Therefore, the objective of the present review is, first, to conduct a literature review and summarize nimodipine pharmacokinetic data and sources of variability in various patient groups. Second, to determine if there is any evidence reporting an association between nimodipine exposure and clinical outcomes in patients with subarachnoid hemorrhage. A systematic literature search was performed in MEDLINE and EMBASE. The following keywords were used: ("nimodipine" OR "nymalize" OR "nimotop") AND ("pharmacokinetic*", OR "PK"). The search results were limited to English language and human studies. A large interpatient variability in nimodipine pharmacokinetics has been reported. Patient-specific factors that had an influence on pharmacokinetic parameters are age, comorbidities, variabilities in metabolism due to genetic polymorphism and co-administered medications, as well as nimodipine administration technique. The association between nimodipine exposure and clinical outcomes remains unclear and data available are too scarce to reach a firm conclusion. Here, we present a narrative review with a systematic literature search discussing nimodipine pharmacokinetic variability in various patient populations. It is not clear if minimal or lack of systemic exposure to nimodipine denies its benefit and contributes to worsening outcomes in patients with subarachnoid hemorrhage. Further studies are needed to determine if such an association exists. Key Points Nimodipine exposure is highly variable among individuals. Age, liver disease, genetic make-up, and nimodipine administration techniques influence nimodipine exposure.

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Section: Effect Of Age On Nimodipine Pharmacokineticssupporting

confidence: 81%

“…Steady-state peak plasma concentrations following oral administration of nimodipine 30 mg every 8 h in healthy individuals, patients with chronic kidney disease (CKD), and subjects with cerebral disorders[31,33,37,48,51,78,[82][83][84][85][86][87] …”

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confidence: 99%

Nimodipine Pharmacokinetic Variability in Various Patient Populations

Mahmoud

Isse

2020

Drugs R D

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“…Nimodipine, a calcium channel blocker used in the prevention of vasospasm secondary to subarachnoid hemorrhage, has shown some efficacy in the treatment of vertigo and dizziness frequently observed in older patients with cerebrovascular disease affecting areas and neural pathways in the CNS involved in vestibular compensation [21]. Nimodipine, by facilitating perfusion and oxygenation of human brain hypoxic areas [113], showed favorable effects on age-related cerebrovascular disorders [114], representing a possible choice in the treatment of vertigo of vascular origin in older patients [115].…”

Section: Vascular Vertigo (Vv)mentioning

confidence: 99%

Current Insights into Treating Vertigo in Older Adults

Casani¹,

Gufoni²,

Capobianco³

2021

Drugs Aging

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The number of older people has been increasing over recent decades in Western populations. Dizziness, imbalance, and vertigo constitute some of the most common complaints in older patients, and risk of falling is the most frequent and worrying consequence. It has been reported that 15-20% of the adult population experiences these debilitating symptoms. Among the diseases that may be associated with vertigo, the three classes of otological, central, and functional (psychological) dizziness may be distinguished. Overall, vestibular disorders account for 48% of vertiginous complaints in the older population. The main focus of this article is to review the forms of pharmacotherapy for vertigo, especially with regard to older patients, who may be treated simultaneously with other drugs for different comorbidities. Interactions with other drugs should be considered in the choice of a particular course of treatment. Moreover, overuse of pharmacotherapy for the management of vertigo in the elderly may prevent the development of the central compensatory mechanism that sustains both static and dynamic imbalance after a vertiginous crisis. In the majority of patients, vestibular and physical rehabilitation are strongly advised and rarely contraindicated.

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