1
|
Kaamini E, Santhoshkumar M. Letter to the editor: "Beyond nimodipine: advanced neuroprotection strategies for aneurysmal subarachnoid hemorrhage vasospasm and delayed cerebral ischemia". Neurosurg Rev 2024; 47:430. [PMID: 39141183 DOI: 10.1007/s10143-024-02694-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2024] [Revised: 07/30/2024] [Accepted: 08/11/2024] [Indexed: 08/15/2024]
Abstract
This letter commends the article by Luzzi et al. on alternative neuroprotection strategies for aneurysmal subarachnoid hemorrhage (SAH). It highlights the pharmacological advantages of nicardipine, cilostazol, and clazosentan over nimodipine in managing cerebral vasospasm and delayed cerebral ischemia. Emphasizing the need for personalized medicine, it advocates for integrating genetic screening and advanced monitoring techniques to tailor treatments to individual patient profiles. This approach could significantly improve clinical outcomes by optimizing drug efficacy and minimizing adverse effects.
Collapse
Affiliation(s)
- E Kaamini
- Private Dental Surgeon, Chennai, Tamil Nadu, India
| | - Murali Santhoshkumar
- Center for Global Health Research, Saveetha Medical College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS), Chennai, Tamil Nadu, India.
| |
Collapse
|
2
|
Luzzi S, Bektaşoğlu PK, Doğruel Y, Güngor A. Beyond nimodipine: advanced neuroprotection strategies for aneurysmal subarachnoid hemorrhage vasospasm and delayed cerebral ischemia. Neurosurg Rev 2024; 47:305. [PMID: 38967704 PMCID: PMC11226492 DOI: 10.1007/s10143-024-02543-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 05/15/2024] [Accepted: 06/24/2024] [Indexed: 07/06/2024]
Abstract
The clinical management of aneurysmal subarachnoid hemorrhage (SAH)-associated vasospasm remains a challenge in neurosurgical practice, with its prevention and treatment having a major impact on neurological outcome. While considered a mainstay, nimodipine is burdened by some non-negligible limitations that make it still a suboptimal candidate of pharmacotherapy for SAH. This narrative review aims to provide an update on the pharmacodynamics, pharmacokinetics, overall evidence, and strength of recommendation of nimodipine alternative drugs for aneurysmal SAH-associated vasospasm and delayed cerebral ischemia. A PRISMA literature search was performed in the PubMed/Medline, Web of Science, ClinicalTrials.gov, and PubChem databases using a combination of the MeSH terms "medical therapy," "management," "cerebral vasospasm," "subarachnoid hemorrhage," and "delayed cerebral ischemia." Collected articles were reviewed for typology and relevance prior to final inclusion. A total of 346 articles were initially collected. The identification, screening, eligibility, and inclusion process resulted in the selection of 59 studies. Nicardipine and cilostazol, which have longer half-lives than nimodipine, had robust evidence of efficacy and safety. Eicosapentaenoic acid, dapsone and clazosentan showed a good balance between effectiveness and favorable pharmacokinetics. Combinations between different drug classes have been studied to a very limited extent. Nicardipine, cilostazol, Rho-kinase inhibitors, and clazosentan proved their better pharmacokinetic profiles compared with nimodipine without prejudice with effective and safe neuroprotective role. However, the number of trials conducted is significantly lower than for nimodipine. Aneurysmal SAH-associated vasospasm remains an area of ongoing preclinical and clinical research where the search for new drugs or associations is critical.
Collapse
Affiliation(s)
- Sabino Luzzi
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.
- Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - Pınar Kuru Bektaşoğlu
- Department of Neurosurgery, University of Health Sciences, Fatih Sultan Mehmet Education and Research Hospital, İstanbul, Türkiye
| | - Yücel Doğruel
- Department of Neurosurgery, Health Sciences University, Tepecik Training and Research Hospital, İzmir, Türkiye
| | - Abuzer Güngor
- Faculty of Medicine, Department of Neurosurgery, Istinye University, İstanbul, Türkiye
| |
Collapse
|
3
|
Vázquez-Medina A, Turnbull MT, James CL, Cowart JB, Lesser E, Carter RE, Ross OA, Miller DA, Meschia JF, De Jesús Espinosa A, Weinshilboum R, Freeman WD. Nimodipine-associated standard dose reductions and neurologic outcomes after aneurysmal subarachnoid hemorrhage: the era of pharmacogenomics. THE PHARMACOGENOMICS JOURNAL 2024; 24:19. [PMID: 38890281 DOI: 10.1038/s41397-024-00340-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 05/16/2024] [Accepted: 06/03/2024] [Indexed: 06/20/2024]
Abstract
Nimodipine, an L-type cerebroselective calcium channel antagonist, is the only drug approved by the US Food and Drug Administration for the neuroprotection of patients with aneurysmal subarachnoid hemorrhage (aSAH). Four randomized, placebo-controlled trials of nimodipine demonstrated clinical improvement over placebo; however, these occurred before precision medicine with pharmacogenomics was readily available. The standard enteral dose of nimodipine recommended after aSAH is 60 mg every 4 h. However, up to 78% of patients with aSAH develop systemic arterial hypotension after taking the drug at the recommended dose, which could theoretically limit its neuroprotective role and worsen cerebral perfusion pressure and cerebral blood flow, particularly when concomitant vasospasm is present. We investigated the association between nimodipine dose changes and clinical outcomes in a consecutive series of 150 patients (mean age, 56 years; 70.7% women) with acute aSAH. We describe the pharmacogenomic relationship of nimodipine dose reduction with clinical outcomes. These results have major implications for future individualized dosing of nimodipine in the era of precision medicine.
Collapse
Affiliation(s)
- Adriana Vázquez-Medina
- University of Puerto Rico, Medical Sciences Campus School of Medicine, San Juan, Puerto Rico
| | | | - Courtney L James
- Department of Emergency Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Jennifer B Cowart
- Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Elizabeth Lesser
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Jacksonville, FL, USA
| | - Rickey E Carter
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Jacksonville, FL, USA
- Department of Artificial Intelligence and Informatics, Mayo Clinic, Jacksonville, FL, USA
| | - Owen A Ross
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
| | - David A Miller
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL, USA
- Division of Neuroradiology, Mayo Clinic, Jacksonville, FL, USA
| | - James F Meschia
- Department of Neurology, Mayo Clinic, Jacksonville, FL, USA
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | | | | | - W David Freeman
- Department of Neurology, Mayo Clinic, Jacksonville, FL, USA.
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL, USA.
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL, USA.
| |
Collapse
|
4
|
Black BJ, Ghazal RE, Lojek N, Williams V, Rajput JS, Lawson JM. Phenotypic Screening of Prospective Analgesics Among FDA-Approved Compounds using an iPSC-Based Model of Acute and Chronic Inflammatory Nociception. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024; 11:e2303724. [PMID: 38189546 PMCID: PMC10953557 DOI: 10.1002/advs.202303724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 11/26/2023] [Indexed: 01/09/2024]
Abstract
Classical target-based drug screening is low-throughput, largely subjective, and costly. Phenotypic screening based on in vitro models is increasingly being used to identify candidate compounds that modulate complex cell/tissue functions. Chronic inflammatory nociception, and subsequent chronic pain conditions, affect peripheral sensory neuron activity (e.g., firing of action potentials) through myriad pathways, and remain unaddressed in regard to effective, non-addictive management/treatment options. Here, a chronic inflammatory nociception model is demonstrated based on induced pluripotent stem cell (iPSC) sensory neurons and glia, co-cultured on microelectrode arrays (MEAs). iPSC sensory co-cultures exhibit coordinated spontaneous extracellular action potential (EAP) firing, reaching a stable baseline after ≈27 days in vitro (DIV). Spontaneous and evoked EAP metrics are significantly modulated by 24-h incubation with tumor necrosis factor-alpha (TNF-α), representing an inflammatory phenotype. Compared with positive controls (lidocaine), this model is identified as an "excellent" stand-alone assay based on a modified Z' assay quality metric. This model is then used to screen 15 cherry-picked, off-label, Food and Drug Administration (FDA)-approved compounds; 10 of 15 are identified as "hits". Both hits and "misses" are discussed in turn. In total, this data suggests that iPSC sensory co-cultures on MEAs may represent a moderate-to-high-throughput assay for drug discovery targeting inflammatory nociception.
Collapse
Affiliation(s)
- Bryan James Black
- Department of Biomedical EngineeringFrancis College of EngineeringUniversity of Massachusetts LowellLowellMA01854USA
| | - Rasha El Ghazal
- Department of Biomedical EngineeringFrancis College of EngineeringUniversity of Massachusetts LowellLowellMA01854USA
| | - Neal Lojek
- Department of Biomedical EngineeringFrancis College of EngineeringUniversity of Massachusetts LowellLowellMA01854USA
| | - Victoria Williams
- Department of Biomedical EngineeringFrancis College of EngineeringUniversity of Massachusetts LowellLowellMA01854USA
| | - Jai Singh Rajput
- Department of Biomedical EngineeringFrancis College of EngineeringUniversity of Massachusetts LowellLowellMA01854USA
| | - Jennifer M. Lawson
- Department of Biomedical EngineeringFrancis College of EngineeringUniversity of Massachusetts LowellLowellMA01854USA
| |
Collapse
|
5
|
Mahmoud SH, Hefny F, Isse FA, Farooq S, Ling S, O'Kelly C, Kutsogiannis DJ. Nimodipine systemic exposure and outcomes following aneurysmal subarachnoid hemorrhage: a pilot prospective observational study (ASH-1 study). Front Neurol 2024; 14:1233267. [PMID: 38249736 PMCID: PMC10796587 DOI: 10.3389/fneur.2023.1233267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 12/07/2023] [Indexed: 01/23/2024] Open
Abstract
Background Nimodipine improves outcomes following aneurysmal subarachnoid hemorrhage (aSAH). Guidelines recommend that all patients should receive a fixed-dose nimodipine for 21 days. However, studies reported variability of nimodipine concentrations in aSAH. It is not clear if reduced systemic exposure contributes to worsening outcomes. The aim of this study was to compare nimodipine systemic exposure in those who experienced poor outcomes to those who experienced favorable outcomes. Methods This was a pilot prospective observational study in 30 adult patients admitted to the University of Alberta Hospital with aSAH. Data were collected from the electronic health records following enrollment. Blood samples were collected around one nimodipine 60 mg dose at a steady state, and nimodipine [total, (+)-R and (-)-S enantiomers] plasma concentrations were determined. The poor outcome was defined as a modified Rankin Scale (mRS) score at 90 days of 3-6, while the favorable outcome was an mRS score of 0-2. The correlation between nimodipine concentrations and percent changes in mean arterial pressure (MAP) before and after nimodipine administration was also determined. Furthermore, covariates potentially associated with nimodipine exposure were explored. Results In total, 20 (69%) participants had favorable outcomes and 9 (31%) had poor outcomes. Following the exclusion of those with delayed presentation (>96 h from aSAH onset), among those presented with the World Federation of Neurological Surgeons (WFNS) grade 3-5, nimodipine median (interquartile range) area under the concentration time curve (AUC0-3h) in those with favorable outcomes were 4-fold higher than in those with poor outcomes [136 (52-192) vs. 33 (23-39) ng.h/mL, respectively, value of p = 0.2]. On the other hand, among those presented with WFNS grade 1-2, nimodipine AUC0-3h in those with favorable outcomes were significantly lower than in those with poor outcomes [30 (28-36) vs. 172 (117-308) ng.h/mL, respectively, value of p = 0.03)]. (+)-R-nimodipine AUC0-3h in those who did not develop vasospasm were 4-fold significantly higher than those who had vasospasm (value of p = 0.047). (-)-S-nimodipine was significantly correlated with percentage MAP reduction. Similar results were obtained when the whole cohort was analyzed. Conclusion The study was the first to investigate the potential association between nimodipine exposure following oral dosing and outcomes. In addition, it suggests differential effects of nimodipine enantiomers, shedding light on the potential utility of nimodipine enantiomers. Larger studies are needed.
Collapse
Affiliation(s)
- Sherif Hanafy Mahmoud
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB, Canada
| | - Fatma Hefny
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB, Canada
| | - Fadumo Ahmed Isse
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB, Canada
| | - Shahmeer Farooq
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB, Canada
| | - Spencer Ling
- Pharmacy Services, University of Alberta Hospital, Alberta Health Services, Edmonton, AB, Canada
| | - Cian O'Kelly
- Vascular, Endovascular and General Neurosurgery, Division of Neurosurgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Demetrios James Kutsogiannis
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| |
Collapse
|
6
|
Esfahani G, Trutschel ML, Reichert D, Mäder K. Characterization of Controlled Release Starch-Nimodipine Implant for Antispasmodic and Neuroprotective Therapies in the Brain. Mol Pharm 2023; 20:5753-5762. [PMID: 37750866 DOI: 10.1021/acs.molpharmaceut.3c00618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
Parenteral depot systems can provide a constant release of drugs over a few days to months. Most of the parenteral depot products on the market are based on poly(lactic acid) and poly(lactide-co-glycolide) (PLGA). Studies have shown that acidic monomers of these polymers can lead to nonlinear release profiles or even drug inactivation before release. Therefore, finding alternatives for these polymers is of great importance. Our previous study showed the potential of starch as a natural and biodegradable polymer to form a controlled release system. Subarachnoid hemorrhage (SAH) is a life-threatening type of stroke and a major cause of death and disability in patients. Nimotop® (nimodipine (NMD)) is an FDA-approved drug for treating SAH-induced vasospasms. In addition, NMD has, in contrast to other Ca antagonists, unique neuroprotective effects. The oral administration of NMD is linked to variable absorption and systemic side effects. Therefore, the development of a local parenteral depot formulation is desirable. To avoid the formation of an acidic microenvironment and autocatalytic polymer degradation, we avoided PLGA as a matrix and investigated starch as an alternative. Implants with drug loads of 20 and 40% NMD were prepared by hot melt extrusion (HME) and sterilized with an electron beam. The effects of HME and electron beam on NMD and starch were evaluated with NMR, IR, and Raman spectroscopy. The release profile of NMD from the systems was assessed by high-performance liquid chromatography. Different spectroscopy methods confirmed the stability of NMD during the sterilization process. The homogeneity of the produced system was proven by Raman spectroscopy and scanning electron microscopy images. In vitro release studies demonstrated the sustained release of NMD over more than 3 months from both NMD systems. In summary, homogeneous nimodipine-starch implants were produced and characterized, which can be used for therapeutic purposes in the brain.
Collapse
Affiliation(s)
- Golbarg Esfahani
- Institute of Pharmacy, Martin Luther University Halle-Wittenberg, Wolfgang-Langenbeck-Straße 4, Halle 06120, Saale, Germany
| | - Marie-Luise Trutschel
- Institute of Pharmacy, Martin Luther University Halle-Wittenberg, Wolfgang-Langenbeck-Straße 4, Halle 06120, Saale, Germany
| | - Detlef Reichert
- Institute of Physics, Martin Luther University Halle-Wittenberg, Betty-Heimann-Str. 7, Halle D-06120, Saale, Germany
| | - Karsten Mäder
- Institute of Pharmacy, Martin Luther University Halle-Wittenberg, Wolfgang-Langenbeck-Straße 4, Halle 06120, Saale, Germany
| |
Collapse
|
7
|
Viana HKMMC, da Silva Oliveira GL, Moreno LCGEAI, de Melo-Cavalcante AAC, de Moura do Amaral MP, Arcanjo DDR, Rolim HML. Involvement of the serotoninergic system in the anxiolytic action mechanism of a liposomal formulation containing nimodipine (NMD-Lipo). Pharmacol Biochem Behav 2023; 232:173654. [PMID: 37802395 DOI: 10.1016/j.pbb.2023.173654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/02/2023] [Accepted: 10/03/2023] [Indexed: 10/10/2023]
Abstract
In the search for anxiolytic drugs with fewer adverse effects, calcium blockers were proposed as a benzodiazepines (BZDs) alternative. In this context, the anxiolytic effect of nimodipine has been demonstrated. However, its low bioavailability and solubility could be improved by using nanostructured drug delivery systems such as liposomes. In this way, liposomal formulation containing nimodipine (NMD-Lipo) was developed. The NMD-lipo is a formulation capable of improving the kinetic characteristics of the drug, as well as the anxiolytic effect of nimodipine. In this work, the serotonergic system participation in the anxiolytic mechanism of the liposomal formulation containing nimodipine (NMD-Lipo) was investigated. A possible 5-HT1A receptor mediation on the NMD-Lipo anxiolytic effect was demonstrated by using WAY 100635 (5-HT1A receptor antagonist) since the antagonist reversed the NMD-Lipo anxiolytic effect in the light/dark test and elevated plus maze test. The results demonstrated that the NMD-Lipo administration had anxiolytic activity through 5-HT1A receptors without causing sedation or compromising the motor coordination of the tested animals.
Collapse
Affiliation(s)
- Hellen Kelen Maria Medeiros Coimbra Viana
- Laboratory of Pharmaceutical Nanosystems (NANOSFAR), Postgraduate Program in Pharmaceutical Sciences, Federal University of Piaui (UFPI), Teresina, PI 64.049-550,Brazil
| | - George Laylson da Silva Oliveira
- Laboratory of Experimental Neurochemistry (LAPNEX), Postgraduate Program in Pharmaceutical Sciences, Federal University of Piaui (UFPI), Teresina, PI 64.049-550,Brazil
| | | | - Ana Amélia Carvalho de Melo-Cavalcante
- Laboratory of Experimental Neurochemistry (LAPNEX), Postgraduate Program in Pharmaceutical Sciences, Federal University of Piaui (UFPI), Teresina, PI 64.049-550,Brazil
| | - Maurício Pires de Moura do Amaral
- Interdisciplinary Neuroscience and Toxicology Laboratory (LINT), PostgraduateProgram in Pharmaceutical Sciences, Federal University of Piaui (UFPI), Teresina, PI 64.049-550, Brazil
| | - Daniel Dias Rufino Arcanjo
- Interdisciplinary Neuroscience and Toxicology Laboratory (LINT), PostgraduateProgram in Pharmaceutical Sciences, Federal University of Piaui (UFPI), Teresina, PI 64.049-550, Brazil
| | - Hercília Maria Lins Rolim
- Laboratory of Pharmaceutical Nanosystems (NANOSFAR), Postgraduate Program in Pharmaceutical Sciences, Federal University of Piaui (UFPI), Teresina, PI 64.049-550,Brazil.
| |
Collapse
|
8
|
Lei G, Rao Z, Hu Y. The efficacy of different nimodipine administration route for treating subarachnoid hemorrhage: A network meta-analysis. Medicine (Baltimore) 2023; 102:e34789. [PMID: 37773855 PMCID: PMC10545353 DOI: 10.1097/md.0000000000034789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 07/26/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND A systematic review and network meta-analysis (NMA) were conducted to explore the optimal administration route of nimodipine for treatment subarachnoid hemorrhage. METHODS Electronic databases (Pubmed, Embase, Web of Science and Cochrane databases) were systematically searched to identify randomized controlled trials evaluating different administration route of nimodipine (intravenous and enteral) versus placebo for treatment subarachnoid hemorrhage. Outcomes included case fatality at 3 months, poor outcome measured at 3 months (defined as death, vegetative state, or severe disability), incidence of delayed cerebral ischemia (DCI), delayed ischemic neurological deficit. A random-effect Bayesian NMA was conducted for outcomes of interest, and results were presented as odds ratios (ORs) and 95% credible intervals. The NMA was performed using R Software with a GeMTC package. A Bayesian NMA was performed and relative ranking of agents was assessed using surface under the cumulative ranking (SUCRA) probabilities. RESULTS Nine randomized controlled trials met criteria for inclusion and finally included in this NMA. There was no statistically significant between intravenous and enteral in terms of case fatality, the occurrence of DCI, delayed ischemic neurologic deficit and poor outcomes (P > .05). Both intravenous and enteral could reduce case fatality, the occurrence of DCI, delayed ischemic neurologic deficit and poor outcomes (P < .05). The SUCRA shows that enteral ranked first, intravenous ranked second and placebo ranked the last for case fatality, the occurrence of DCI and poor outcomes. The SUCRA shows that intravenous ranked first, enteral ranked second and placebo ranked the last for delayed ischemic neurologic deficit. CONCLUSIONS It is possible that both enteral and intravenous nimodipine have comparable effectiveness in preventing poor outcomes, DCI, and delayed ischemic neurological deficits. However, further investigation may be necessary to determine the exact role of intravenous nimodipine in current clinical practice.
Collapse
Affiliation(s)
- Gang Lei
- Department of Neurology, Tianyou Hospital Affiliated to Wuhan University of Science and Technolog, Wuhan, China
| | - Zhongxian Rao
- Hospital of Wuhan University of science and technology, Wuhan, China
| | - Yuping Hu
- Hubei University of Chinese Medicine, Wuhan, China
| |
Collapse
|
9
|
Mahmoud SH, Hefny FR, Panos NG, Delucilla L, Ngan Z, Perreault MM, Hamilton LA, Rowe AS, Buschur PL, Owusu-Guha J, Almohaish S, Sandler M, Armahizer MJ, Barra ME, Cook AM, Barthol CA, Hintze TD, Cantin A, Traeger J, Blunck JR, Shewmaker J, Burgess SV, Kaupp K, Brown CS, Clark SL, Wieruszewski ED, Tesoro EP, Ammar AA, Ammar MA, Binning MJ, Naydin S, Fox N, Peters DM, Mahmoud LN, Keegan SP, Brophy GM. Comparison of nimodipine formulations and administration techniques via enteral feeding tubes in patients with aneurysmal subarachnoid hemorrhage: A multicenter retrospective cohort study. Pharmacotherapy 2023; 43:279-290. [PMID: 36880540 DOI: 10.1002/phar.2791] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 01/07/2023] [Accepted: 02/12/2023] [Indexed: 03/08/2023]
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.
Collapse
Affiliation(s)
- Sherif Hanafy Mahmoud
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Fatma R Hefny
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Nicholas G Panos
- Department of Pharmacy, Rush University Medical Center, Chicago, Illinois, USA
| | - Laura Delucilla
- Department of Pharmacy, McGill University Health Centre, Montreal, Quebec, Canada
| | - Zinquon Ngan
- Department of Pharmacy, McGill University Health Centre, Montreal, Quebec, Canada
| | - Marc M Perreault
- Department of Pharmacy, McGill University Health Centre, Montreal, Quebec, Canada.,Faculty of Pharmacy, Université de Montréal, Montreal, Quebec, Canada
| | - Leslie A Hamilton
- University of Tennessee Health Science Center, College of Pharmacy, Knoxville, Tennessee, USA
| | - A Shaun Rowe
- University of Tennessee Health Science Center, College of Pharmacy, Knoxville, Tennessee, USA
| | | | | | - Sulaiman Almohaish
- Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University, School of Pharmacy, Richmond, Virginia, USA.,College of Clinical Pharmacy, King Faisal University, Al-Ahsa, Saudi Arabia
| | - Melissa Sandler
- Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University, School of Pharmacy, Richmond, Virginia, USA.,Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, School of Medicine, Richmond, Virginia, USA
| | - Michael J Armahizer
- Pharmacy Services, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Megan E Barra
- Department of Pharmacy, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Aaron M Cook
- UKHealthCare, University of Kentucky College of Pharmacy, Lexington, Kentucky, USA
| | - Colleen A Barthol
- Department of Pharmacotherapy & Pharmacy Services, University Health, San Antonio, Texas, USA
| | - Trager D Hintze
- Department of Pharmacy Practice, Texas A&M College of Pharmacy, College Station, Texas, USA
| | - Anna Cantin
- Hartford Hospital, Hartford, Connecticut, USA
| | - Jessica Traeger
- University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Joseph R Blunck
- Department of Pharmacy, Saint Luke's Hospital, Kansas City, Missouri, USA
| | - Justin Shewmaker
- Department of Pharmacy, Saint Luke's Hospital, Kansas City, Missouri, USA
| | - Sarah V Burgess
- Queen Elizabeth II Health Sciences Centre, Nova Scotia Health, Halifax, Nova Scotia, Canada
| | - Kristin Kaupp
- Queen Elizabeth II Health Sciences Centre, Nova Scotia Health, Halifax, Nova Scotia, Canada
| | | | | | | | - Eljim P Tesoro
- College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Abdalla A Ammar
- Department of Pharmacy, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Mahmoud A Ammar
- Department of Pharmacy, Yale New Haven Hospital, New Haven, Connecticut, USA
| | | | | | - Neal Fox
- Premier Health Miami Valley Hospital, Dayton, Ohio, USA
| | - David M Peters
- Cedarville University School of Pharmacy, Cedarville, Ohio, USA
| | - Leana N Mahmoud
- Department of Pharmacy, Rhode Island Hospital/Lifespan, Providence, Rhode Island, USA
| | - Shaun P Keegan
- Department of Pharmacy, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
| | - Gretchen M Brophy
- Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University, School of Pharmacy, Richmond, Virginia, USA
| |
Collapse
|
10
|
Medina-Suárez J, Rodríguez-Esparragón F, Sosa-Pérez C, Cazorla-Rivero S, Torres-Mata LB, Jiménez-O’Shanahan A, Clavo B, Morera-Molina J. A Review of Genetic Polymorphisms and Susceptibilities to Complications after Aneurysmal Subarachnoid Hemorrhage. Int J Mol Sci 2022; 23:ijms232315427. [PMID: 36499752 PMCID: PMC9739720 DOI: 10.3390/ijms232315427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 11/28/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022] Open
Abstract
Delayed cerebral ischemia (DCI) and vasospasm are two complications of subarachnoid hemorrhages (SAHs) which entail high risks of morbidity and mortality. However, it is unknown why only some patients who suffer SAHs will experience DCI and vasospasm. The purpose of this review is to describe the main genetic single nucleotide polymorphisms (SNPs) that have demonstrated a relationship with these complications. The SNP of the nitric oxide endothelial synthase (eNOS) has been related to the size and rupture of an aneurysm, as well as to DCI, vasospasm, and poor neurological outcome. The SNPs responsible for the asymmetric dimetilarginine and the high-mobility group box 1 have also been associated with DCI. An association between vasospasm and the SNPs of the eNOS, the haptoglobin, and the endothelin-1 receptor has been found. The SNPs of the angiotensin-converting enzyme have been related to DCI and poor neurological outcome. Studies on the SNPs of the Ryanodine Receptor yielded varying results regarding their association with vasospasm.
Collapse
Affiliation(s)
- Jose Medina-Suárez
- Research Unit, University Hospital of Gran Canaria Dr. Negrín, 35010 Gran Canaria, Spain
- Department of Specific Teaching Methodologies, University of Las Palmas de Gran Canaria, 35004 Gran Canaria, Spain
- Correspondence: (J.M.-S.); (F.R.-E.)
| | - Francisco Rodríguez-Esparragón
- Research Unit, University Hospital of Gran Canaria Dr. Negrín, 35010 Gran Canaria, Spain
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias, Universidad de La Laguna, 38296 Tenerife, Spain
- CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Correspondence: (J.M.-S.); (F.R.-E.)
| | - Coralia Sosa-Pérez
- Neurosurgery Unit, University Hospital of Gran Canaria Dr. Negrín, 35010 Gran Canaria, Spain
- Department of Medical and Surgery Sciences, University of Las Palmas de Gran Canaria, 35016 Gran Canaria, Spain
| | - Sara Cazorla-Rivero
- Research Unit, University Hospital of Gran Canaria Dr. Negrín, 35010 Gran Canaria, Spain
- University of La Laguna, 38200 Tenerife, Spain
| | - Laura B. Torres-Mata
- Research Unit, University Hospital of Gran Canaria Dr. Negrín, 35010 Gran Canaria, Spain
| | | | - Bernardino Clavo
- Research Unit, University Hospital of Gran Canaria Dr. Negrín, 35010 Gran Canaria, Spain
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias, Universidad de La Laguna, 38296 Tenerife, Spain
- CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, 28029 Madrid, Spain
- RETIC de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), 28029 Madrid, Spain
- Instituto de Salud Carlos III, 28029 Madrid, Spain
- Chronic Pain Unit, University Hospital of Gran Canaria Dr. Negrín, 35010 Gran Canaria, Spain
- Radiation Oncology Department, University Hospital of Gran Canaria Dr. Negrín, 35010 Las Palmas de Gran Canaria, Spain
| | - Jesús Morera-Molina
- Neurosurgery Unit, University Hospital of Gran Canaria Dr. Negrín, 35010 Gran Canaria, Spain
- Department of Medical and Surgery Sciences, University of Las Palmas de Gran Canaria, 35016 Gran Canaria, Spain
| |
Collapse
|
11
|
Fritzsche S, Strauss C, Scheller C, Leisz S. Nimodipine Treatment Protects Auditory Hair Cells from Cisplatin-Induced Cell Death Accompanied by Upregulation of LMO4. Int J Mol Sci 2022; 23:ijms23105780. [PMID: 35628594 PMCID: PMC9145067 DOI: 10.3390/ijms23105780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/17/2022] [Accepted: 05/19/2022] [Indexed: 12/04/2022] Open
Abstract
Ototoxicity is one of the main dose-limiting side effects of cisplatin chemotherapy and impairs the quality of life of tumor patients dramatically. Since there is currently no established standard therapy targeting hearing loss in cisplatin treatment, the aim of this study was to investigate the effect of nimodipine and its role in cell survival in cisplatin-associated hearing cell damage. To determine the cytotoxic effect, the cell death rate was measured using undifferentiated and differentiated UB/OC−1 and UB/OC−2 cells, after nimodipine pre-treatment and stress induction by cisplatin. Furthermore, immunoblot analysis and intracellular calcium measurement were performed to investigate anti-apoptotic signaling, which was associated with a reduced cytotoxic effect after nimodipine pre-treatment. Cisplatin’s cytotoxic effect was significantly attenuated by nimodipine up to 61%. In addition, nimodipine pre-treatment counteracted the reduction in LIM Domain Only 4 (LMO4) by cisplatin, which was associated with increased activation of Ak strain transforming/protein kinase B (Akt), cAMP response element-binding protein (CREB), and signal transducers and activators of transcription 3 (Stat3). Thus, nimodipine presents a potentially well-tolerated substance against the ototoxicity of cisplatin, which could result in a significant improvement in patients’ quality of life.
Collapse
|
12
|
Ye H, Liu Z, Zhou L, Cai Q. Effect of nimodipine combined with fasudil on vascular endothelial function and inflammatory factors in patients with cerebral vasospasm induced by aneurysmal subarachnoid hemorrhage. Am J Transl Res 2022; 14:2617-2624. [PMID: 35559390 PMCID: PMC9091089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 12/12/2021] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Aneurysmal subarachnoid hemorrhage (aSAH) is an acute disease with rapid progression and critical condition. The most common complication of aSAH is cerebral vasospasm (CVS). Patients are predisposed to severe cerebral ischemia, brain injury, or even death if effective measures are not taken in time to relieve symptoms. This study mainly determines the effect of nimodipine (NM) combined with fasudil on vascular endothelial function (VEF) and inflammatory factors (IFs) in patients with aSAH induced CVS. METHODS The clinical data of 77 patients with aSAH induced CVS treated in the Renmin Hospital of Wuhan University from March 2019 to June 2020 were analyzed retrospectively. Based on different drug therapies, patients receiving NM monotherapy were assigned to the control group (n=32), while those treated with NM combined with fasudil were included in the observation group (n=45), both received two consecutive weeks of treatment. The two arms were compared regarding the following items: clinical efficacy, average blood flow velocities (BFVs) of anterior, posterior and middle cerebral arteries, serum IFs, levels of vascular endothelial growth factor (VEGF), ET-1 and CGRP, cognitive function (Montreal Cognitive Assessment Scale, MOCA), activities of daily living (Bathel index), and adverse reactions. RESULTS The overall response rate of the observation group was significantly higher than that of the control group (P<0.05). After treatment, the BFVs of the anterior, posterior and middle cerebral arteries in the observation group decreased significantly compared with the control group (P<0.05). ET-1 and VEGF decreased in both groups, while CGRP increased, with more significant changes in the observation group (P<0.05). Serum IFs reduced in both arms, with more evident reductions in the observation group (P<0.05). The MOCA score and Barthel index increased statistically in both arms and were higher in the observation group compared with the control group (P<0.05). There was no significant difference in the total incidence of adverse reactions between the observation group and the control group (P>0.05). CONCLUSIONS NM combined with fasudil in the treatment of aSAH induced CVS can effectively improve the VEF, alleviate IFs, and enhance the cognitive function and quality of life of patients, which is worth popularizing in clinic.
Collapse
Affiliation(s)
- Hui Ye
- Department of Neurosurgery, Renmin Hospital of Wuhan University Wuhan 430060, Hubei, China
| | - Zaiming Liu
- Department of Neurosurgery, Renmin Hospital of Wuhan University Wuhan 430060, Hubei, China
| | - Long Zhou
- Department of Neurosurgery, Renmin Hospital of Wuhan University Wuhan 430060, Hubei, China
| | - Qiang Cai
- Department of Neurosurgery, Renmin Hospital of Wuhan University Wuhan 430060, Hubei, China
| |
Collapse
|
13
|
Abdelghafour MM, Orbán Á, Deák Á, Lamch Ł, Frank É, Nagy R, Ziegenheim S, Sipos P, Farkas E, Bari F, Janovák L. Biocompatible poly(ethylene succinate) polyester with molecular weight dependent drug release properties. Int J Pharm 2022; 618:121653. [PMID: 35278604 DOI: 10.1016/j.ijpharm.2022.121653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 02/04/2022] [Accepted: 03/07/2022] [Indexed: 01/05/2023]
Abstract
In the present study, we demonstrate that well-known molecular weight-dependent solubility properties of a polymer can also be used in the field of controlled drug delivery. To prove this, poly(ethylene succinate) (PES) polyesters with polycondensation time regulated molecular weights were synthesized via catalyst-free direct polymerization in an equimolar ratio of ethylene glycol and succinic acid monomers at 185 °C. DSC and contact angle measurements revealed that increasing the molecular weight (Mw, 4.3-5.05 kDa) through the polymerization time (40-80 min) increased the thermal stability (Tm= ∼61-80 °C) and slightly the hydrophobicity (Θw= ∼27-41°) of the obtained aliphatic polyester. Next, this biodegradable polymer was used for the encapsulation of Ca2+ channel blocker Nimodipine (NIMO) to overcome the poor water solubility and enhance the bioavailability of the drug. The drug/ polymer compatibility was proved by the means of solubility (δ) and Flory-Huggins interaction (miscibility) parameters (χ). The nanoprecipitation encapsulation of NIMO into PES with increasing Mw resulted in the formation of spherical 270 ± 103 nm NIMO-loaded PES nanoparticles (NPs). Furthermore, based on the XRD measurements, the encapsulated form of NIMO-loaded PES NPs showed lower drug crystallinity, which enhanced not only the water solubility but even the water stability of the NIMO in an aqueous medium. The in-vitro drug release experiments demonstrated that the release of NIMO drug could be accelerated or even prolonged by the molecular weights of PES as well. Due to the low crystallinity of PES polyester and low particle size of the encapsulated NIMO drug led to enhance solubility and releasing process of NIMO from PES with lower Mw (4.3 kDa and 4.5 kDa) compared to pure crystalline NIMO. However, further increasing the molecular weight (5.05 kDa) was already reduced the amount of drug release that provides the prolonged therapeutic effect and enhances the bioavailability of the NIMO drug.
Collapse
Affiliation(s)
- Mohamed M Abdelghafour
- Department of Physical Chemistry and Materials Science, University of Szeged, H-6720, Rerrich Béla tér 1, Szeged, Hungary; Department of Chemistry, Faculty of Science, Zagazig University, Zagazig 44519, Egypt
| | - Ágoston Orbán
- Department of Physical Chemistry and Materials Science, University of Szeged, H-6720, Rerrich Béla tér 1, Szeged, Hungary
| | - Ágota Deák
- Department of Physical Chemistry and Materials Science, University of Szeged, H-6720, Rerrich Béla tér 1, Szeged, Hungary
| | - Łukasz Lamch
- Department of Organic and Pharmaceutical Technology, Faculty of Chemistry, Wrocław University of Science and Technology, Wybrzeże Wyspiańskiego 27, 50-370 Wrocław, Poland
| | - Éva Frank
- Department of Organic Chemistry, University of Szeged, Dóm tér 8, H-6720 Szeged, Hungary
| | - Roland Nagy
- Department of MOL Department of Hydrocarbon and Coal Processing, Faculty of Engineering, University of Pannonia, Egyetem Str. 10, H-8200 Veszprém, Hungary
| | - Szilveszter Ziegenheim
- Department of Inorganic and Analytical Chemistry, University of Szeged, Dóm tér 7, H-6720 Szeged, Hungary
| | - Pál Sipos
- Department of Inorganic and Analytical Chemistry, University of Szeged, Dóm tér 7, H-6720 Szeged, Hungary
| | - Eszter Farkas
- Department of Medical Physics and Informatics, Faculty of Medicine & Faculty of Science and Informatics, University of Szeged, Korányi Fasor 9, H-6720 Szeged, Hungary; HCEMM-USZ Cerebral Blood Flow and Metabolism Research Group, University of Szeged, Dugonics Square 13, H-6720 Szeged, Hungary; Department of Cell Biology and Molecular Medicine, Faculty of Science and Informatics & Faculty of Medicine, University of Szeged, Somogyi Str. 4, H-6720 Szeged, Hungary
| | - Ferenc Bari
- Department of Medical Physics and Informatics, Faculty of Medicine & Faculty of Science and Informatics, University of Szeged, Korányi Fasor 9, H-6720 Szeged, Hungary
| | - László Janovák
- Department of Physical Chemistry and Materials Science, University of Szeged, H-6720, Rerrich Béla tér 1, Szeged, Hungary.
| |
Collapse
|