From the Research
Nimodipine is typically administered at a dose of 60 mg orally every 4 hours for 7-10 days for recurrent laryngeal nerve (RLN) injury. Treatment should begin as soon as possible after the injury is identified, ideally within 24 hours. The medication should be continued for the full course even if improvement is noted earlier. Nimodipine works as a calcium channel blocker that improves microcirculation and reduces calcium-mediated nerve damage, potentially enhancing nerve regeneration and functional recovery after RLN injury. This medication may help reduce the duration and severity of vocal cord paralysis by improving blood flow to the injured nerve and decreasing secondary neural damage.
Key Considerations
- Patients should be monitored for potential side effects including hypotension, headache, and flushing 1.
- Blood pressure should be checked regularly during treatment, especially in the first few days.
- If significant hypotension occurs (systolic BP <90 mmHg), dose reduction to 30 mg every 4 hours may be considered.
- Nimodipine should be used cautiously in patients with liver disease, as dose adjustments may be necessary.
Evidence Support
The use of nimodipine for RLN injury is supported by a systematic review and meta-analysis that found it significantly increased the odds of vocal fold motion recovery 1. Additionally, studies have shown that nimodipine improves reinnervation and neuromuscular function after injury to the recurrent laryngeal nerve 2, 3, 4. However, the most recent and highest quality study, a systematic review and meta-analysis published in 2019, provides the strongest evidence for the use of nimodipine in this context 1.