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Pharmacogenomics of Cytochrome P450 of Nimodipine Metabolism After Aneurysmal Subarachnoid Hemorrhage

Peacock, Sarah H.; James, Courtney; Turnbull, Marion T.; Cowart, Jennifer B.; Reid, Joel M.; Freeman, W. David

Journal of Neuroscience Nursing: October 2019 - Volume 51 - Issue 5 - p 238–242
doi: 10.1097/JNN.0000000000000464
Pharmacology Update

ABSTRACT INTRODUCTION: Aneurysmal subarachnoid hemorrhage (aSAH) is a type of stroke that is life threatening with high rates of mortality, and many survivors are left with permanent neurologic deficits. Nimodipine is the treatment of choice for aSAH with the goal of reduction of delayed cerebral ischemia. It is the only evidence-based medication that has been shown to have improved outcomes for delayed cerebral ischemia; therefore, it is important for neuroscience nurses to be knowledgeable of the pharmacology and pharmacogenomics properties of this medication, including cytochrome P450 (CYP450) enzymes. METHODS AND RESULTS: This article reviews the CYP450 enzyme system including a review of the pharmacotherapy and pharmacogenomics of nimodipine for patients with aSAH illustrated with case study of a patient with abnormal drug metabolism. CONCLUSION: CYP450 enzymes can be inhibited or induced by multiple medications resulting in clinically significant differences in drug metabolism. Food and Drug Administration–approved medication nimodipine is the only medication shown to improve outcomes in patients with aSAH. Hence, it is important to have awareness of potential drug-to-drug interactions and pharmacogenomics of nimodipine when caring for critically ill patients with aSAH.

Courtney James, MD, Mayo Clinic School of Medicine, Rochester, MN.

Marion T. Turnbull, PhD, Department of Neuroscience, Mayo Clinic, Jacksonville, FL.

Jennifer B. Cowart, MD, Department of Hospital Internal Medicine, Mayo Clinic, Jacksonville, FL.

Joel M. Reid, PhD, Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN.

W. David Freeman, MD, Departments of Neurologic Surgery, Neurology, Critical Care, Mayo Clinic, Jacksonville, FL.

Questions or comments about this article may be directed to Sarah H. Peacock, DNP APRN, at Department of Critical Care, Mayo Clinic, Jacksonville, FL.

All authors contributed to the conception, design, image acquisition, and writing of the article. They all had final approval of the submitted manuscript.

The authors declare no conflicts of interest.

Online date: August 30, 2019

© 2019 American Association of Neuroscience Nurses