Clinical aspects of the use of calcium antagonists in cerebrovascular disease.

Calcium antagonists may be useful for certain cerebrovascular conditions. In addition to producing a variable amount of cerebral vascular relaxation, high doses of some of these drugs may block calcium entry into neurons. Clinical trials in patients with vasospasm have clearly shown that calcium antagonists can improve outcome. Clinical trials in patients with acute stroke have been inconclusive, and have been flawed by delayed patient entry. Cardiovascular side effects may limit the safety and efficacy of calcium antagonists in acute stroke patients. Further investigation of early treatment with cerebroselective agents, possibly in conjunction with complementary therapies, is needed.