Tirilazad mesylate, a nonglucocorticoid 21-aminosteroid, has been used in two 
randomized, double-blind, vehicle-controlled trials in Europe, Australia, New 
Zealand, and in North America in patients with aneurysmal subarachnoid 
hemorrhage. The first trial has been concluded, enrolled 1023 patients, and 
demonstrated a dramatic reduction in mortality from 27% to 3% (p = 0.01) in 
males receiving 6 mg/kg/day tirilazad for 10 days, when compared to 
vehicle-treated patients. There was also a less incidence of symptomatic 
vasospasm, and the frequency of hypertensive-hypervolemic-hemodilution therapy 
was significantly reduced. The reduction in mortality rate was remarkable, 
however the benefits of treatment with tirilazad were predominantly shown in men 
rather than in women. This clinical trial suggest that tirilazad mesylate, at a 
dosage of 6 mg/kg/day, improves overall outcome in aneurysmal subarachnoid 
hemorrhage patients. Further data from the North America trial and the trial in 
women receiving higher doses of tirilazad are still pending.