Background and Purpose: A meta-analysis compared the outcome of the 1,855 patients receiving oral nimodipine 120 mg daily against the 1,864 receiving placebo using all the data from nine controlled studies of nimodipine in acute ischemic stroke, pursuing findings of subgroup analyses which, in some studies, suggested an important effect on outcome of early therapy and of severity subgroups. Methods: The neurological outcome was classified as ''favorable'' when the patient improved by more than 50% of their potential to improve related to the baseline neurological score (whatever the scale), as compared to patients who either died, deteriorated, did not change, or improved by 50% or less. A favorable functional outcome was defined as a Barthel score of more than 60 for those studies using this scale or the equivalent on the Mathew disability scale. Results: The pooled odds ratio favored nimodipine for the 330 patients treated within 12 h (OR 0.62, 95% CI 0.44–0.87) versus the 286 on placebo. Those treated between 13 and 24 h (451 drug, 459 placebo) had no benefits, and those treated after 24 h (803 drug, 841 placebo) had no effect or a worse clinical outcome. The effect was more evident when the initial neurological scores showed moderate to severe impairments. No significant effect on outcome was found in the overall cohort for age, sex, risk factors of diabetes, hypertension, or heart disease. Conclusions: These findings, from pooling data on over 3,700 patients, support the view that early therapy with oral nimodipine may favorably influence the course of acute ischemic stroke.