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J Neurol Surg A Cent Eur Neurosurg 2014; 75(02): 084-090
DOI: 10.1055/s-0033-1337608
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Enteral or Parenteral Nimodipine Treatment: A Comparative Pharmacokinetic Study

Christian Scheller
1   Department of Neurosurgery, University of Halle-Wittenberg, Halle, Germany
,
Andreas Wienke
2   Institue for Medical Epidemiology, University of Halle-Wittenberg, Halle, Germany
,
Franziska Wurm
1   Department of Neurosurgery, University of Halle-Wittenberg, Halle, Germany
,
Anne-Sophie Vogel
1   Department of Neurosurgery, University of Halle-Wittenberg, Halle, Germany
,
Sebastian Simmermacher
1   Department of Neurosurgery, University of Halle-Wittenberg, Halle, Germany
,
Julian Prell
1   Department of Neurosurgery, University of Halle-Wittenberg, Halle, Germany
,
Jens Rachinger
1   Department of Neurosurgery, University of Halle-Wittenberg, Halle, Germany
,
Gershom Koman
1   Department of Neurosurgery, University of Halle-Wittenberg, Halle, Germany
,
Christian Strauss
1   Department of Neurosurgery, University of Halle-Wittenberg, Halle, Germany
,
Konstanze Scheller
3   Department of Oral and Maxillofacial Plastic Surgery, University Halle-Wittenberg, Halle, Germany
› Author Affiliations
Further Information

Publication History

01 August 2012

25 November 2012

Publication Date:
15 March 2013 (online)

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Abstract

Background and Study Aims/Object Oral nimodipine is recommended to reduce poor outcome related to aneurysmal subarachnoid hemorrhage (SAH). In addition, animal experiments and clinical trails revealed a beneficial effect of enteral and parenteral nimodipine for the regeneration of cranial nerves following skull base, laryngeal, and maxillofacial surgery. Despite these findings there is a lack of pharmacokinetic data in the literature, especially concerning its distribution in nerve tissue.

Patients/Material and Methods Samples were taken from a consecutive series of 57 patients suffering from skull base lesions and treated with nimodipine prophylaxis from the day before surgery until the seventh postoperative day. Both groups received standard dosages for enteral (n = 25) and parenteral (n = 32) nimodipine . Nimodipine levels were measured in serum, cerebrospinal fluid (CSF), and tissue samples, including vestibular nerves.

Results Nimodipine levels were significantly higher following parenteral as compared with enteral administration for intraoperative serum (p < 0.001), intraoperative CSF (p < 0.001), tumor tissues (p = 0.01), and postoperative serum (p < 0.001). In addition, nimodipine was significantly more frequently detected in nerve tissue following parenteral administration (Fisher's exact test, p = 0.015).

Conclusions From a pharmacokinetic point of view, parenteral nimodipine medication leads to higher levels in serum and CSF. Furthermore, traces are more frequently found in nerve tissue following parenteral as compared with enteral nimodipine administration, at least in the early course.

Keywords

nimodipine - pharmacokinetic - subarachnoid hemorrhage - skull base surgery
 

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