Drug therapy

The calcium channel blocking drug nimodipine (Nimotop) is routinely given for 21 days after SAH to prevent vasospasms and to enhance collateral blood flow.
Anticonvulsants are given as prophylaxis against seizures.
Stool softeners prevent constipation and straining at stool, which results in the patient performing a Valsalva maneuver. The Valsalva maneuver increases intracranial pressure and blood pressure, two factors that are associated with aneurysmal rebleeding.
The use of steroids is controversial. However, some clinicians believe that steroids are beneficial for treatment of cerebral edema and the inflammatory effect of meningeal irritation.
Analgesics such as acetaminophen or codeine are given to control headache.
Sedatives such as phenobarbital may be given to the agitated patient at risk for elevated blood pressure.
The osmotic diuretic mannitol may be given to decrease cerebral edema, improve cerebral blood flow, and decrease neurological deficits. A decrease in cerebral edema lowers both ICP and systemic blood pressure.
Volume expansion can improve perfusion during vasospasm. Hypotension should be avoided, as it can cause decreased cerebral perfusion.
If the patient is hypertensive, antihypertensive drugs may be given to prevent rebleeding. A therapeutic goal systolic pressure is approximately l30 mm. Hg.