Possible reactions include: a potentially dangerous drop in blood pressure, or hypotension. Pantoni 2000 reported analyses based on the intentionto treat (ITT) and the validforefficacy population. Proceedings of the 1st International Nimotop Symposium, Munich, 1984, Nimodipine in the treatment of senile brain deterioration: Polycentric controlled study of the Italian group for the study of geriatric therapy, Divergent neuroprotectrive effects of nimodipine in PPD and MID provide indirect evidence of disturbances in Ca2+ homeostasis in dementia, Methods and Findings in Experimental and Clinical Pharmacology. Fischhof PK, Although often used together, concurrent use of calcium-channel blockers and beta-blockers may result in additive hypotensive, negative inotropic, and/or bradycardic effects in some patients. New search for studies and content updated (no change to conclusions). This review has been peer reviewed by two external experts, National Library of Medicine Soglian AG, Over the years 1975 to 2000, the world population increased by a quarter to around six billion people. The test is focused on transfer to, and retrieval from longterm memory. Ban 1990 MMSE 90 mg/day dose at 12 weeks for measures on: There was little variation in the duration of the trials, with all but one of the parallel trials being of 12 weeks duration. Vascular dementia Zamperini D, The rationale for its use is to restrict the influx of calcium ions into neurons, and, by vasodilatation, to improve blood flow to the brain. Comparison 1 Nimodipine vs placebo (all types of dementia), Outcome 3 CGI Numbers improved compared with baseline. Beneke M, Mattis dementia scale Do not administer nimodipine intravenously or by other parenteral routes. HasseSander I, In common with other antidementia drugs currently available, nimodipine does not swiftly improve manifestations of the disease but rather seems to slow progression. An additional report of Pantoni 2000 examined the response to nimodipine of two subgroups of cerebrovascular dementia, those diagnosed as subcortical vascular dementia due to small vessel disease and the remainder which were regarded as multiinfarct dementia. Severity of dementia at baseline (as defined by each cognitive scale, for example mild, MMSE greater than 17, and moderate MMSE 1710). When the same rating scale or test is used in all trial in a metaanalysis the weighted mean difference is calculated. He armed himself with a balaclava, latex gloves, condoms and Viagra pills and posed as a cab driver in a Mercedes to roam the streets of Brighton, East Sussex. The improvement may not last beyond 26 weeks of treatment. Last updated on May 5, 2023. The study authors were contacted to clarify, Short portable mental state questionnaire, General status, by relative's assessment and symptomatology questionnaire, No placebo group. The total score is the sum of the subtest scores. One crossover trial was 2 x 6 months and one was 2 x 8 weeks. Careers, Unable to load your collection due to an error. Comparison 2 Nimodipine vs placebo (primary degenerative dementia), Outcome 5 Clinical Global Impression Severity of disease. 90 mg/day at 24 weeks for measures on: Review first published: Issue 4, 1997. Calcium ions are ubiquitous messengers linking membrane excitation to subsequent intracellular molecular responses. The details are shown below. Comparison 1 Nimodipine vs placebo (all types of dementia), Outcome 5 Clinical Global Impression Severity of disease. [4] [8] It is unclear if it is effective for treating sexual dysfunction in women. Potential benefits. Pharmacological companies were also contacted for information on trials and individual patient data. Cavallini A, Unclassified dementia Comparison 1 Nimodipine vs placebo (all types of dementia), Outcome 19 number of patients with at least one adverse event (skeletal) during treatment. Details of the search strategies used for the retrieval of reports of trials from the healthcare databases, CENTRAL and conference proceedings can be viewed in the methods used in reviews section within the editorial information about the Dementia and Cognitive Improvement Group. Cheng S, Pantoni L, This is an updated review containing more extensive data than were included in the first version. Each time point provides a separate assessment. Paroxetine is one of the selective serotonin reuptake inhibitors (SSRIs) used in the treatment of premature ejaculation (PE). Comparison 1 Nimodipine vs placebo (all types of dementia), Outcome 17 number of patients with at least one adverse event of urogenital problems during treatment. If possible, data were sought on every patient for each outcome measure. Smith FW. to investigate whether nimodipine effects a clinically relevant improvement in elderly patients with diffuse organic brain syndrome and a defined pattern of symptoms, to determine the therapeutic effect of nimodipine on the symptoms of chronic cerebrovascular insufficiency and on psychic performance, To evaluate the efficacy and tolerability of nimodipine 90 and 180 mg/day in PDD patients, to evaluate the efficacy of nimodipine in improving cognition or slowing cognitive deterioration in patients with VD, to evaluate the effect of nimodipine on mental performance in senile vascular dementia. Cognitive function: Bono G, Last updated on May 5, 2023. WAIS digit span test Adan GO, Karukin M. Nimodipine in the treatment of primary degenerative dementia, International Symposium on Calcium Antagonists Pharmacology and Clinical Research, Brain, aging and calcium antagonists drugs. Photo: Andreas Neumann. Comparison 3 Nimodipine vs placebo (vascular dementia), Outcome 6 Activities of Daily Living. 8. Zeng 1996 which was previously awaiting assessment has been excluded because participants were not randomised to treatment. The metaanalyses were carried out on the basis of the results from the analyses of data of those who completed treatment (completers' analyses). activities of daily living: [SMD 0.12, 95% CIs 0.23, 0.0, P = 0.04], 180 mg/day dose at 24 weeks for measures on: Singer E, The performance of instrumental activities of daily living functions is usually assessed by an informant close to the patient. The efficacy of nimodipine, a calcium channel blocker, has been tested in randomized controlled trials for the treatment of dementia, particularly Alzheimer's disease and multiinfarct dementia, the commonest forms of dementia in older people. Only two treatment regimes were tested, 90 and 180 mg/day of nimodipine, divided into three equal doses. 90 mg/day dose at 12 weeks for measures on: ZimmermannMeinzingen S. Effects of Nimodipine and Piracetam on speed of information processing (ZVTG) and clinical dementia symptomsresults of a unicentre randomized clinical trial, Zeitschrift Fur Gerontopsychologie Und Psychiatrie. dizziness. There are 14 included studies which examined cognitive, function and global effects, safety and tolerability of nimodipine compared with placebo. When the only statistic available was an F or t value, the standard deviation calculated from these values was applied across all treatment groups. The metaanalyses of the number of patients suffering at least one adverse autonomic event by the end of treatment shows benefit for placebo compared with the 90 mg/day dose of nimodipine at 24 weeks (7/128 nimodipine, 1/131 placebo) [OR 4.79, 95% CI 1.17, 19.51 P = 0.03]. However, this use is not approved in many countries. Mutschler E. Pharmacokinetics of nimodipine in multimorbid elderly patients with chronic brain failure. PDS Progressive deterioration scale Comparison 3 Nimodipine vs placebo (vascular dementia), Outcome 8 number of patients with at least one adverse event by end of treatment. Inzitari D, The type of intentionto treat analysis (e.g. Tobares 1989 PADL. This remains of insufficient size to address the secondary but important issue of which subgroups of patients stand to gain and those for whom nimodipine offers no benefit or even harm. There is also a risk of stroke and heart attack. Unlike other calcium channel blockers, nimodipine produces its antivasoconstrictive and antiischaemic effects primarily in the brain at low dosage, most evidently on smaller arterioles determining regional blood flow. This review found evidence of some shortterm benefit attributable to nimodipine, mainly in measures of cognitive function and global impression, but not in activities on daily living, for patients with degenerative and multiinfarct dementia, and mixed dementia. 1. alltype dementia at: Sildenafil (Viagra), vardenafil (Levitra, Staxyn), tadalafil (Cialis) and avanafil (Stendra) are oral medications that reverse erectile dysfunction by enhancing the effects of nitric oxide, a . Although dementia due to Alzheimer's disease and vascular causes is a chronic disease with a median life expectancy of several years from the time of diagnosis, the trials have all been of short duration (typically lasting 12 weeks) with the longest study being 52 weeks but whose data has not been included for the reasons given above (Pantoni 2005). Branconnier RJ, Morich 1996 GERRI Calcium ions link membrane excitation to subsequent intracellular molecular responses. ADASCog (Rosen 1984) covers the relevant domains and ability ranges, and is sensitive to the changes of interest in clinical trials of antidementia drugs. The main domains where benefit for patients treated with nimodipine was seen, were in overall status and in cognitive function, when all types of dementia were pooled. Cognitive function (as measured by psychometric tests) Geriatric Evaluation by Relative's Rating Instrument (GERRI) (Schwartz 1983) consists of 49 questions, each rated on a 5point frequency scale, designed to assess the frequency of typical behavioural disturbances and complaints in cognitive functioning, social functioning and mood. Additional hypotheses to be tested were that nimodipine had no differential effect, when compared with placebo, for certain subgroups of patients: 1. Mouzo R, The search of August 2005 identified two studies which were excluded. Ruther E, Any bias this may have introduced may be small as the numbers who did not complete treatment were low and there did not appear to be large differences in dropout rates for treatment and placebo groups, except for one trial where losses were more frequent in the placebo (41 out of 118) than in the nimodipine group (17 out of 124), mainly related to adverse events of any kind (Pantoni 2005). Divitis O, However, these analyses were based only on participants who completed the study and are not intentiontotreat analyses. Accessibility Pantoni 2000 MMSE For this medicine, the following should be considered: Allergies The reporting within the paper of the individual patient data for the CGI allows us to carry out such an analysis. Mixed Alzheimer's and vascular dementia A multicentre latinamerican study. Some high blood pressure medicines can affect sex drive or the quality of sex. Comparison 3 Nimodipine vs placebo (vascular dementia), Outcome 1 SCAG change from baseline. Efficacy and safety of nimodipine in subcortical vascular dementia: a randomized placebocontrolled trial, Nimodipine treatment improves cognitive functions in vascular dementia, The use of nimodipine in vascular dementia. The trials considered in this review contained many different scales, some of which are not validated and some of which did not use any of the common scales. CGIseverity of disease: [WMD 0.01, 95% CI 0.07, 0.05, P = 0.7] Rohmel J, 6. government site. approximation to a normal distribution) and provide standard deviations and standard errors. The only conclusion that can be drawn from the analyses presented by Pantoni is that there seems to be little effect of nimodipine in either group. Crossover studies are inappropriate for a progressive diseases such as dementia. The metaanalyses are based on data from participants who completed the studies. We searched ALOIS (www.medicine.ox.ac.uk/alois) the Cochrane Dementia and Cognitive Improvement Groups Specialized Register on 26 March 2010. All the trials used 90 mg/day in one arm, placebo in a second, and two trials had a third arm of 180 mg/day. ADL: [SMD 0.08, 95% CI 0.21, 0.04, P = 0.19], 2. primary degenerative dementia at: Other aspects of trial quality were not assessed by a scoring system although details were noted of blinding, whether intentiontotreat analyses were extractable from the published data, and the number of patients lost to followup. Nimodipine is well tolerated with a low rate of adverse effects similar to that associated with placebo. et al. Dorn 1985 Digit symbol Comparison 1 Nimodipine vs placebo (all types of dementia), Outcome 16 number of patients with at least one adverse event of a gastrointestinal problem during treatment. Available for Android and iOS devices. Baumel B, Sim TC, ADAScog Alzheimer's disease assessment score, cognitive component (Rosen 1984) *PSMS Physical self maintenance scale Safety (as measured by the incidence of adverse effects, including adverse effects leading to withdrawal. For the evaluation of efficacy it was not possible to extract results from five trials, resulting in loss of 674 patients for analysis, in particular Branconnier 1988 (227 patients) and Kanowski 1989 (197 patients), and in the loss of the trials with severely demented patients. Comparison 1 Nimodipine vs placebo (all types of dementia), Outcome 8 Withdrawals before end of treatment due to an adverse event. . CGIseverity of disease: [WMD 0.40, 95% CI 0.82, 0.02, P = 0.06] Pantoni L, Amigoni S, Any potent substance can cause side effects, and dapoxetine is not an exception. . Branconnier 1988 also used the LOCF population but only if patients completed 10 of 12 weeks. This is especially so for outcome measures that are described in the protocol as "secondary", or where the protocol does not prespecify primary and secondary outcome measures. poor control over ejaculation. Calcium antagonists and multiinfarct dementia: A trial involving sequential NMR and psychometric assessment, International Journal of Geriatric Psychiatry. The assessment of self care capacity in geriatric psychiatric patients by objective and subjective measures, Assessment of the older people: Selfmaintaining and instrumental activities of daily living, The Cochrane Library [database on disk and CDROM], A memory test for longitudinal measurement of mild to moderate deficits, A new rating scale for Alzheimer's disease. Inand exclusion of studies: JAL and JB Warnings 1. Note: This document contains side effect information about nimodipine. Villavicencio de Ojeda A, Maio L, Treatment of cerebrovascular insufficiency (multiinfarct dementia) with nimodipine in elderly patients. Celano P, Morich 1996 used the last observation carried forward (LOCF). ADL: [SMD 0.16, 95% CI 0.65, 0.32, P = 0.5] Such studies should report results from the first treatment period separately. Li DJ. Avanafil is used to treat erectile dysfunction ( impotence ). Memory tests form a subdivision of cognitive tests and were originally developed for the appraisal of major dimensions of memory function in adults. An official website of the United States government. The current match involves a Texas lawsuit . We are still in the process of obtaining this. Schuback G, In evaluating the evidence from patients with dementia key issues include the aetiological type of dementia, severity of the disease and comorbidity. Eisner LS, Gold L, [, Nimodipine: New prospect for senile dementia, Comparison of efficacy between nimodipine and hydergine in the treatment of vascular dementia, Chinese Journal of Clinical Neurosciences. Bethesda, MD 20894, Web Policies After a firstassess and a deduplication of these results the authors were left with two references to further assess. London psychogeriatric scale Inzitari D, Ser T, Experimental group was treated with nimodipine plus Hydergine (dihydroergotamine mesilate), Crosssectional study with no randomization. Available outcome data from nine trials (2492 patients) cover the domains of cognitive function, activities of daily living, global clinical state, safety and tolerability. Ser T, Viagra), vardenafil, avanafil (Stendra) and tadalafil (Adcirca, Cialis, others). Comparison 1 Nimodipine vs placebo (all types of dementia), Outcome 22 number of patients with at least one adverse event of an autonomic problem during treatment. Parnetti L, Wang LN, Acuto G, Morich 1996 1996 MMSE Trials in which the allocation to treatment or placebo was not random, or in which treatment allocation was not concealed, were excluded. After being assessed they were excluded. 3) Scores of cognition: The usefulness of nimodipine in patients with Alzheimer's disease and vascular dementia and unspecified dementia is still controversial. Palliation of the progressive memory impairment of Alzheimer's disease by nimodipine, Calcium channel blocker nimodipine for primary degenerative dementia, Shortterm effects of the calcium channel blocker nimodipine (Baye9736) in the management of primary degenerative dementia, Effect of nimodipine on the wellbeing, symptoms and efficiency of ambulatory patients with cerebrovascular disorders, Nimodipine. These side effects may go away during treatment as your body adjusts to the medicine. The second phase will be based on individualpatient data. HiersemenzeI R, Applies to nimodipine: oral capsule liquid filled, oral solution. Wallin A, Data sources include IBM Watson Micromedex (updated 5 June 2023), Cerner Multum (updated 5 June 2023), ASHP (updated 10 Apr 2023) and others. Fischhof P, Reisberg B, Perea JE, People with unclassified dementia, Alzheimer's disease, cerebrovascular dementia or mixed Alzheimer's and cerebrovascular dementia as diagnosed by accepted criteria such as DSM IIIR, NINCDSADRDA (National Institute of Neurological, Communicative Disorders and StrokeAlzheimer's Disease and Related Disorders) criteria, and NINCDSAIREN (National Institute of Neurological Disorders and Stroke or ICD (International Classification of Diseases). Lemme L, Nimodipine is an isopropyl calcium channel blocker which readily crosses the bloodbrain barrier. The mean treatment effect and the standard errors for each trial were calculated from reported information if not stated explicitly in the text. GBS Gottfries, Brane and Steen scale Although not all of these side effects may occur, if they do occur they may need medical attention. overall clinical improvement, such as: official website and that any information you provide is encrypted The trial reports showed that nearly all outcomes were treated as continuous variables. An update search of January 2008 identified six studies for consideration by the authors. Calcium has an important role in regulating brain functions. ED is commonly reported among patients with PE. The metaanalyses of the number of patients suffering at least one adverse event due to a blood problem by the end of treatment shows benefit for the 90 mg/day dose of nimodipine at 24 weeks compared with placebo (13/664 nimodipine, 26/682 placebo) [OR 0.52, 95% CI 0.27, 0.98 P = 0.04]. activities on daily living, ADL: [SMD 0.16, 95% CI 0.65, 0.32, P = 0.5] Calcium has a pervasive role in regulating brain functions (e.g. Erkkinjuntti T, Alfuzosin may cause a sudden drop in your blood pressure, which could lead to dizziness or fainting, usually within a few hours after you take it. Adverse event the total score is the sum of the selective serotonin reuptake inhibitors SSRIs. Excluded because participants were not randomised to treatment document contains side effect information about nimodipine not nimodipine. Register on 26 March 2010 calculated from reported information if not stated explicitly in the.! 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