In the management of subarachnoid hemorrhage due to aneurysm, which medication is used to prevent vasospasm?

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Preventing delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage hinges on reducing cerebral vasospasm. Nimodipine, a calcium channel blocker with good brain penetration, specifically helps prevent vasospasm by relaxing cerebral arterial smooth muscle. This action lowers the risk and severity of vasospasm and improves neurologic outcomes after SAH. It is the medication of choice for this purpose and is typically given orally for several weeks after the bleed. The other drugs listed do not target cerebral vasospasm: an ACE inhibitor lowers systemic blood pressure, an antiviral treats infections such as herpes, and an antiemetic addresses nausea but not cerebral vessel tone.