Causes of Noncompliance With Nimodipine and Its Impact on 90-day Outcome After Aneurysmal Subarachnoid Hemorrhage

Guidelines recommend the use of enteral nimodipine for 21 days after aneurysmal subarachnoid hemorrhage (aSAH). The recommended duration (21 d) and frequency of administration (every 4 h) may lead to noncompliance. Nurses play a critical role in medication administration, monitoring adverse reactions, and ensuring patient compliance with prescribed regimens. The aim of this study is to assess the degree of compliance with nimodipine use, causes of noncompliance and explore if adherence to nimodipine in clinical practice correlates with improved neurological outcomes as indicated by modified Rankin Scale (mRS) scores. A retrospective study of consecutive aSAH admissions to a comprehensive stroke center over a 67-month period. Compliance was defined as receiving at least 80% of the recommended doses of nimodipine over 21 days. A chart review was performed to explore the reasons for noncompliance. We examined hospital disposition at discharge and 90-day mRS, adjusted for severity of aSAH. Compliance rates before and after a pharmacist-guided intervention were also examined. Among 141 patients, the overall compliance rate was just 30%. The leading reasons for missed doses included hypotension (68.1%) and patients being off the unit (56%). Compliance was not associated with improvement in 90-day mRS scores for low-grade aSAH (P=0.3638) and high-grade aSAH (P=0.227). After pharmacist-guided intervention, compliance improved from 18.2% to 43.8%. There is a high rate of noncompliance with nimodipine use in aSAH, but it did not significantly impact patient outcomes. Although pharmacist interventions improved compliance, full compliance remains challenging.