2026 Eastern States Conference

Authors 
Catherine Murphy, PharmD; Andrew Webb, PharmD; Riley Johnson, PharmD 
 
Learning Objective 
Describe outpatient nimodipine prescribing practices upon hospital discharge in patients with aneurysmal subarachnoid hemorrhage. 

Background/Objective
It is unclear if the full 21-day nimodipine course is needed for patients with aneurysmal subarachnoid hemorrhage (aSAH) who are ready for discharge prior to day 21. Thus, we assessed nimodipine prescription rates at discharge in patients with aSAH. 

Methods
This was a single-center, retrospective cohort study of adults (age ≥18 years) admitted for the management of aSAH who were treated with nimodipine during their hospitalization and discharged prior to day 14. Data collected included age, sex, past medical history, aneurysm characteristics, duration of hospitalization, duration of inpatient nimodipine, and outpatient nimodipine prescribing information. The primary outcome was the rate of nimodipine continuation after discharge, which was defined as a prescription being issued to an outpatient pharmacy. Secondary outcomes included the duration of hospitalization;, the duration of outpatient nimodipine treatment;, number of 90-day follow-up appointments;, rehospitalizations,; occurrence of cerebral vasospasm and delayed cerebral ischemia during admission,; and occurrence of rebleeds.

Results
A total of 94 patients admitted between 2016 and 2025 were assessed, of which 88 patients were included. The median age was 55.5 years, and 58 patients (66%) were female. The median modified Fisher and Hunt Hess scores were 3 and 2, respectively. Overall, 47 patients (53.4%) were issued a prescription for nimodipine at discharge. Of the patients prescribed nimodipine, 3 (6.4%) were nonadherent to nimodipine therapy, 8 (17%) had documentation of adherence, and 36 (76.6%) of patients had unknown adherence. 4 patients who continued nimodipine had a significant finding on their follow-up angiogram, defined as a recurrence of aneurysm or evidence of vasospasm, compared to 8 patients in those who did not continue it (11% vs. 20%; p=0.05).  

Conclusion
In patients with aSAH ready for discharge prior to completing their nimodipine, we found that nearly half of patients were not prescribed nimodipine at hospital discharge if medically ready for discharge prior to day 14 of hospitalization. We intended to evaluate functional outcomes, but due to a lack of follow-up appointments within the time frame of interest, these data were not available. Future studies with stricter prescribing practices assessing outpatient nimodipine and clinical status would be useful to determine the necessity of a complete course of nimodipine.