Sin Jonathan H, Shafeeq Hira, Levy Zachary D
Department of Pharmacy, Massachusetts General Hospital, Boston, MA
College of Pharmacy and Health Sciences, St. John's University, Queens, NY.
Am J Health Syst Pharm. 2018 Sep 15;75(18):1369-1377. doi: 10.2146/ajhp170677.
The uses of nimodipine for otolaryngic indications are reviewed, and recommendations for its use in clinical practice are provided.
Nimodipine is currently indicated for the improvement of neurologic outcomes in adult patients with aneurysmal subarachnoid hemorrhage (aSAH). However, other oral and i.v. calcium channel blockers have not exhibited the same beneficial effects in patients with aSAH, leading clinicians to believe that nimodipine possesses unique neuroprotective effects in addition to its calcium channel-blocking and vasodilatory properties. Consequently, clinical investigations of nimodipine have been conducted for cochlear and facial nerve preservation after vestibular schwannoma (VS) surgery, symptomatic management of Ménière's disease and peripheral vertigo, and recovery of vocal cord paralysis after laryngeal nerve injury. Three prospective randomized studies have investigated nimodipine for hearing and/or nerve preservation in patients undergoing VS resection, the results of which have suggested a potential benefit of initiating nimodipine during the perioperative period. Several studies of Ménière's disease and/or peripheral vertigo have reported improved symptom control with nimodipine. For vocal fold paralysis associated with recurrent laryngeal nerve (RLN) injury, nimodipine may increase the recovery rate based on the results of 1 nonrandomized prospective study that used nimodipine in a protocolized manner. One small pilot study found that nimodipine improved facial nerve function after maxillofacial surgery.
Due to its proposed vasoactive and neuroprotective effects, nimodipine may play a role in the treatment of a number of otolaryngic pathologies including VS, Ménière's disease, peripheral vertigo, RLN injury, and facial weakness after maxillofacial surgery. Small studies have shown improved symptom control and recovery after surgery. Since all of the aforementioned indications are still considered off label, clinicians and patients should collaboratively assess the risks and benefits before initiating treatment.
综述尼莫地平在耳鼻喉科适应症中的应用，并提供其在临床实践中的使用建议。
尼莫地平目前被用于改善成人动脉瘤性蛛网膜下腔出血（aSAH）患者的神经学预后。然而，其他口服和静脉注射的钙通道阻滞剂在aSAH患者中并未表现出相同的有益效果，这使得临床医生认为尼莫地平除了具有钙通道阻滞和血管舒张特性外，还具有独特的神经保护作用。因此，已经开展了关于尼莫地平在前庭神经鞘瘤（VS）手术后保留耳蜗和面神经、梅尼埃病和周围性眩晕的症状管理以及喉返神经损伤后声带麻痹恢复方面的临床研究。三项前瞻性随机研究调查了尼莫地平在VS切除患者中对听力和/或神经的保留作用，其结果表明在围手术期开始使用尼莫地平可能有益。几项关于梅尼埃病和/或周围性眩晕的研究报告称，尼莫地平可改善症状控制。对于与喉返神经（RLN）损伤相关的声带麻痹，基于一项以标准化方式使用尼莫地平的非随机前瞻性研究结果，尼莫地平可能会提高恢复率。一项小型试点研究发现，尼莫地平可改善颌面手术后的面神经功能。
由于其拟有的血管活性和神经保护作用，尼莫地平可能在多种耳鼻喉科疾病的治疗中发挥作用，包括VS、梅尼埃病、周围性眩晕、RLN损伤以及颌面手术后的面部无力。小型研究表明，尼莫地平可改善症状控制和术后恢复。由于上述所有适应症仍被视为非适应症用药，临床医生和患者在开始治疗前应共同评估风险和益处。
