Other medications under evaluation

Calcium-induced injury is central to neurocellular damage. Nimodipine, a calcium-channel antagonist, has been shown to have no overall efficacy, although it may be effective in a subgroup of patients with traumatic subarachnoid hemorrhage.

Steroids in high doses have not been shown to be effective and their administration is not recommended since they contribute to morbidity.

21-Amino steroids are much more potent antioxidants without any hormonal effects. They inhibit iron-dependent lipid peroxidation, thus preventing free-radical production. Tirilizad mesylate is undergoing phase III prospective evaluation.

Polyethylene glycol superoxide dismutase is an oxygen free-radical scavenger. Phase II clinical trials have shown safety and efficacy, although a recent unpublished phase III trial in the United States failed to confirm initial findings.

In situations where conventional ICP control has failed, reducing transcapillary pressure with dihydroergotamine as a precapillary vasoconstrictor and with systemic hypotensive agents while maintaining colloid oncotic pressure with albumin has led to improved mortality compared with a matched historical control group.

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