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While considered a mainstay, nimodipine is burdened by some non-negligible limitations that make it still a suboptimal candidate of pharmacotherapy for SAH. This narrative review aims to provide an update on the pharmacodynamics, pharmacokinetics, overall evidence, and strength of recommendation of nimodipine alternative drugs for aneurysmal SAH-associated vasospasm and delayed cerebral ischemia. A PRISMA literature search was performed in the PubMed\/Medline, Web of Science, ClinicalTrials.gov, and PubChem databases using a combination of the MeSH terms \u201cmedical therapy,\u201d \u201cmanagement,\u201d \u201ccerebral vasospasm,\u201d \u201csubarachnoid hemorrhage,\u201d and \u201cdelayed cerebral ischemia.\u201d Collected articles were reviewed for typology and relevance prior to final inclusion. A total of 346 articles were initially collected. The identification, screening, eligibility, and inclusion process resulted in the selection of 59 studies. Nicardipine and cilostazol, which have longer half-lives than nimodipine, had robust evidence of efficacy and safety. Eicosapentaenoic acid, dapsone and clazosentan showed a good balance between effectiveness and favorable pharmacokinetics. Combinations between different drug classes have been studied to a very limited extent. Nicardipine, cilostazol, Rho-kinase inhibitors, and clazosentan proved their better pharmacokinetic profiles compared with nimodipine without prejudice with effective and safe neuroprotective role. However, the number of trials conducted is significantly lower than for nimodipine. Aneurysmal SAH-associated vasospasm remains an area of ongoing preclinical and clinical research where the search for new drugs or associations is critical.<\/jats:p>","DOI":"10.1007\/s10143-024-02543-5","type":"journal-article","created":{"date-parts":[[2024,7,5]],"date-time":"2024-07-05T02:02:01Z","timestamp":1720144921000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":27,"title":["Beyond nimodipine: advanced neuroprotection strategies for aneurysmal subarachnoid hemorrhage vasospasm and delayed cerebral ischemia"],"prefix":"10.1007","volume":"47","author":[{"given":"Sabino","family":"Luzzi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P\u0131nar Kuru","family":"Bekta\u015fo\u011flu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Y\u00fccel","family":"Do\u011fruel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abuzer","family":"G\u00fcngor","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,7,5]]},"reference":[{"key":"2543_CR1","doi-asserted-by":"publisher","first-page":"1096","DOI":"10.1111\/cns.13222","volume":"25","author":"BJ Daou","year":"2019","unstructured":"Daou BJ, Koduri S, Thompson BG, Chaudhary N, Pandey AS (2019) Clinical and experimental aspects of aneurysmal subarachnoid hemorrhage. 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