Administer nimodipine orally, 60 mg every 4 hours, for 21 days post-subarachnoid hemorrhage (SAH). Begin treatment within 96 hours of the SAH event.
Closely monitor blood pressure. Nimodipine can cause hypotension, particularly in patients with pre-existing hypertension. Adjust dosage or consider alternative antihypertensive medications as needed. Target blood pressure should be individualized based on patient characteristics and comorbidities.
Observe for adverse effects. Common side effects include headache, flushing, and nausea. Report significant adverse effects to the attending physician immediately. Hepatic and renal function should be monitored, especially in patients with pre-existing liver or kidney disease.
Maintain consistent medication administration. Missed doses significantly reduce efficacy. Explore strategies with the patient and family to ensure adherence to the prescribed regimen. Consider using pill organizers or setting medication reminders.
Regularly assess neurological status. Perform daily neurological examinations to detect any signs of vasospasm, including changes in level of consciousness, focal neurological deficits, or new onset seizures. Act promptly on any significant changes.
| Dosage | 60 mg every 4 hours |
| Duration | 21 days |
| Onset of Treatment | Within 96 hours post-SAH |
| Monitoring | Blood pressure, neurological status, liver and kidney function |
| Adverse Effects | Headache, flushing, nausea, hypotension |
Incorporate transcranial Doppler (TCD) monitoring to detect early signs of vasospasm. This allows for timely intervention should vasospasm develop despite prophylactic nimodipine treatment. Adjust treatment plans based on TCD findings and clinical presentation.
Maintain open communication with the patient and family regarding treatment goals, potential side effects, and the importance of adherence. Address any concerns promptly and provide clear explanations. Patient education is paramount for successful prophylactic management.
