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What Medications Do You Take After a Stroke

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Top Takeaways

  • Many different kinds of medications are available for stroke treatment and management.
  • Treatment will be individualized for each stroke survivor and will depend on the type of stroke, what caused it, and other preexisting conditions.
  • Some medications will be used for only a few months, while others need to be taken for a long time to prevent recurrent strokes.
  • The best way to prevent recurrent strokes is to take medications as prescribed and have regular check-ups.
  • When having a stroke, every minute counts. If you suspect that a loved one is having a stroke, call 911 immediately and mention the word stroke. 

 

Stroke Background

According to the American Heart Association (AHA), about 1 in every 19 deaths in the United States is attributable to stroke. A stroke, or brain attack, happens when blood flow to part of the brain is blocked. The longer the blockage, the more serious the damage. According to the American Stroke Association, there are four types of stroke:

  • Ischemic Stroke: Happens when blood supply to part of the brain is blocked by a clot or plaque.
  • Hemorrhagic Stroke: Happens when a blood vessel in the brain bursts or ruptures.
  • Transient Ischemic Attack (TIA): TIA, or ministroke, is temporary and symptoms only last a few minutes up to 24 hours.
  • Cryptogenic Stroke: Strokes that have no known cause.

 

Medications After Stroke

Many different kinds of medications are available for stroke treatment and management. Stroke treatment will be individualized for each patient and will depend on the type of stroke, what caused it, and other preexisting conditions.

These are the most commonly prescribed medications after stroke:

 

Antithrombotic medications:

Antithrombotic medications, also known as blood thinners, prevent clots from getting bigger but do not dissolve existing clots. Since antithrombotic drugs make people bleed more easily, always tell your loved one’s healthcare provider about these medications before any surgeries or other medical and dental procedures.

There are two types of antithrombotic medications:

 

Anticoagulants

Anticoagulants reduce the risk of stroke by slowing down clotting and reducing fibrin formation, thus preventing blood from forming clots and existing clots from getting bigger.

Some commonly prescribed anticoagulants include heparin and warfarin (Coumadin, Jantoven)

For warfarin:  

  • Your loved one may need regular blood tests to check warfarin levels in the blood.
  • Grapefruit and grapefruit juice increase the amount of warfarin in the blood, which increases the risk of bleeding. Avoid taking together.
  • Foods rich in vitamin K, such as leafy green and cruciferous vegetables like kale, spinach, broccoli, and cabbage, make warfarin less effective. It is ok to eat these foods while taking warfarin, as long as your loved one eats the same amount every day to help keep the amount of warfarin in the blood the same. 
  • Warfarin also interacts with many drugs and natural products. Speak with your loved one’s healthcare provider or pharmacist for more information.

Direct-acting oral anticoagulants (DOACs), such as rivaroxaban (Xarelto), apixaban (Eliquis), edoxaban (Savaysa) and dabigitran (Pradaxa), are also commonly used. DOACs work differently than warfarin, require less monitoring and have fewer dietary restrictions. 

 

Antiplatelets

Antiplatelets reduce the risk of stroke by preventing blood cells, called platelets, from sticking together and forming clots and existing clots from getting bigger.

Some commonly prescribed antiplatelets include Clopidogrel (Plavix) and Aspirin/ Dipyridamole (Aggrenox)

 

Thrombolytic medications:

 Not to be confused with antithrombotic medications, thrombolytic, or clot-busting, medications dissolve existing clots.

Alteplase (tPA) is a commonly used thrombolytic medication:

Alteplase, or tPA, short for tissue plasminogen activator, is an intravenous injection (in the vein) commonly used for emergency treatment of acute ischemic stroke. 

Your loved one’s neurologist or neurology team will determine whether or not to administer tPA, based on many factors, the most important one being how much time has passed since stroke symptoms started.

For some eligible patients, neurosurgeons may also perform an endovascular mechanical thrombectomy, which is a surgery that places a catheter from the groin up to the blocked blood vessel in the brain. The surgeon then physically pulls out the clot from the blood vessel using a device called a stent retriever.

 

Blood pressure medications

High blood pressure, or hypertension, puts your loved one at a higher risk for stroke. When blood pressure is constantly high, it can damage blood vessels in the brain, which increases the risk of stroke. 

Blood pressure medications help lower and control blood pressure and reduce stroke risk. Some commonly prescribed blood pressure medications include:

 

Thiazide diuretics (water pills)

Help the body get rid of extra salt and water, which lowers blood pressure. Thiazide diuretics include chlorthalidone (Hygroton), chlorothiazide (Diuril) and hydrochlorothiazide (Microzide)

 

Beta-blockers 

Block the effect of stress hormones, like adrenaline, lowering the heart rate (pulse) and the force of heart contractions, thus reducing blood pressure. These include atenolol (Tenormin) and propranolol (Inderal)

 

Calcium channel blockers 

Block calcium from entering the heart and blood vessels, helping lower the force of heart contractions and opening up and relaxing blood vessels, thus lowering blood pressure. Examples include Nifedipine (Adalat, Procardia) and amlodipine (Norvasc, Lotrel)

 

Angiotensin-converting enzyme inhibitors (ACE inhibitors)  

Prevent an enzyme from making angiotensin II, a hormone that constricts (narrows) blood vessels, causing blood vessels to relax and open up and lowering blood pressure. Examples include lisinopril (Prinivil, Zestril) and ramipril (Altace)

 

Angiotensin II receptor blockers (ARBs) 

Block the action of angiotensin II, a hormone that constricts (narrows) blood vessels, thus opening them up and reducing blood pressure. Examples include valsartan (Diovan) and losartan (Cozaar)

Your loved one’s healthcare provider will determine which blood pressure medication is best for them depending on their age, race, underlying conditions, and other factors.

 

High cholesterol medications

Cholesterol is a fatty substance naturally found in the body. The liver makes all the cholesterol the body needs to function properly.

Cholesterol is also found in food. There are two kinds of cholesterol: good cholesterol (HDL) and bad cholesterol (LDL). Too much bad cholesterol from food can lead to the building up of plaque in the walls of blood vessels, making them narrower, which can eventually lead to blood clots and stroke.

Statins are very effective in protecting your loved one from having another stroke. Statins help lower the amount of plaque in blood vessels and prevent more from building up and breaking off, thus reducing stroke risk. Some people will need to take statins even if their cholesterol levels are normal.

Some commonly prescribed statins include atorvastatin (Lipitor) and simvastatin (Zocor). 

NOTE: This is not a complete list of medications used after a stroke. Your loved one’s healthcare provider may prescribe other medications, such as diabetes medications, antidepressants, and pain medications depending on their response to the stroke, both physically and emotionally.

 

How to Reduce Medication Side Effects?

Just like any other medication, stroke medications can have undesirable side effects. While some side effects are unavoidable, many can be avoided by doing the following:

  • Taking medications as prescribed
  • Not missing any doses
  • Telling your loved one’s healthcare provider and pharmacist about all the medications they are taking, including over-the-counter medications, vitamins, supplements, and natural products. 

 

Future outlook

Clinical trials are ongoing at the National Institutes of Health (NIH) and other major institutions to help find new and improved treatments for stroke and its complications. Speak with your loved one’s healthcare provider for the most up-to-date information about stroke treatment and management.

 

Suraya Hammoudeh, PharmD

A clinical Pharmacist with a decade of experience working with health conditions, including Alzheimer’s, Diabetes, high blood pressure, and Heart Disease.

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