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Original article Magnesium as an adjunct to nimodipine in subarachnoid hemorrhage: a meta-analysis
Riva Satya Radiansyah1orcid, Yuri Pamungkas1orcid, Ilham Ikhtiar2orcid
Journal of Yeungnam Medical Science 2025;42:26.
DOI: https://doi.org/10.12701/jyms.2025.42.26 [Epub ahead of print]
Published online: February 2, 2025

1Faculty of Medicine and Health, Institut Teknologi Sepuluh Nopember, Surabaya, Indonesia

2Department of Neurology, Faculty of Medicine, Universitas Airlangga – Dr. Soetomo General Academic Hospital, Surabaya, Indonesia

Corresponding author:  Riva Satya Radiansyah,
Email: riva.satya@its.ac.id
Received: 25 November 2024   • Revised: 10 January 2025   • Accepted: 26 January 2025
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Background
Subarachnoid hemorrhage (SAH) is a devastating neurological condition with high morbidity and mortality rates. Although nimodipine is widely used in the management of SAH, the potential benefits of magnesium as adjunct therapy remain unclear. This meta-analysis aimed to evaluate the efficacy and safety of combining magnesium with nimodipine for the management of SAH.
Methods
A comprehensive literature search was conducted using PubMed, ScienceDirect, Google Scholar, and the Cochrane Library. Randomized controlled trials and prospective cohort studies comparing magnesium plus nimodipine versus nimodipine alone in patients with SAH were included. Key outcomes included cerebral vasospasm (CV), delayed cerebral ischemia (DCI), functional outcomes, mortality, and adverse events.
Results
Twelve studies involving 2,338 patients were included. The combination of magnesium and nimodipine significantly reduced the incidence of CV (odds ratio [OR], 0.53; 95% confidence interval [CI], 0.29–0.95; p=0.03) and DCI (OR, 0.52; 95% CI, 0.31–0.87; p=0.01) compared to nimodipine alone. However, no significant differences were found in functional outcomes (modified Rankin Scale: OR, 0.97; p=0.75; Glasgow Outcome Scale: OR, 0.81; p=0.24), mortality (OR, 0.97; p=0.83), or secondary cerebral infarction (OR, 0.38; p=0.12). The incidence of adverse events was higher in the combination group; however, this difference was not statistically significant (OR, 3.14; p=0.33).
Conclusion
Adding magnesium to nimodipine therapy in patients with SAH may help reduce CV and DCI incidence but does not significantly improve functional outcomes or mortality. Further large-scale studies are needed to optimize the dosing regimens and confirm these findings.

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