Nicardipine Hydrochloride

In patient‑derived glioma stem cells (SU4 and SU5), the calcium channel blocker nicardipine enhanced the cytotoxic and pro‑apoptotic effects of temozolomide while inhibiting autophagy. This effect was mediated by activation of mTOR; the mTOR inhibitor rapamycin abolished nicardipine’s sensitizing action. In vivo, nicardipine plus temozolomide reduced tumor growth. The authors propose repurposing nicardipine as an adjuvant to improve temozolomide efficacy in glioblastoma multiforme by suppressing autophagic survival pathways.

Fig. 1 GSCs characteristic analysis and cell survival assay evaluating GSCs sensitivity to TMZ and nicardipine. (Shi J, et al., 2021)

In a single‑masked RCT (41 patients with high‑grade aneurysmal subarachnoid hemorrhage), intraoperative placement of 10 nicardipine‑releasing implants (4 mg each) around basal cerebral vessels significantly reduced moderate‑to‑severe angiographic vasospasm at days 7–9 (20% vs. 58% in controls, P=0.02) and the need for rescue vasospasm therapy (10% vs. 58%, P=0.002). New cerebral infarcts occurred in 10% vs. 32% (P=0.13). No safety issues emerged. Local nicardipine implants effectively prevent proximal vasospasm, warranting a phase 3 trial.

Fig. 2 CONSORT Flow Diagram. (Wessels L, et al., 2024)