A stroke is the result of interruption of blood flow to the brain due to blockage or bleeding. The blood vessels supplying the brain are very narrow and fragile. As a result, blood vessels are at risk of being damaged and ruptured by small clots or elevated blood pressure.
Ultimately, if blood flow to the brain is interrupted for a prolonged period of time, it is called an injury ischemia happens in the brain. Brain tissue cannot regenerate, so damage in the brain is permanent. The consequences of a stroke can be serious.
Fortunately, medications are available to reduce the risk of cerebrovascular events, such as stroke, and prevent the development of future strokes. Studies have shown that after a first stroke, the risk of future strokes is about 12%. Therefore, most medical treatments focus on reducing the risk of recurrent stroke.
A form of stroke occurs when someone begins to experience symptoms of a stroke, but then the symptoms quickly subside and go away. This is called a stroke or transient ischemic attack (TIA).
While a stroke may not cause lasting damage, it is still a serious event. Stroke is a risk factor for future strokes. It should be followed by prompt medical evaluation and treatment to prevent more permanent damage.
This article will discuss medicines used to treat conditions that can lead to a stroke, as well as medicines used to treat conditions that develop after a stroke.
Anticoagulants and blood thinners
The formation of clots and the breakdown of clots depend on platelets (blood cells that are active in clotting) and various proteins in the blood. Drugs target different aspects of the clotting process.
One of the first drugs used to treat stroke was antiplatelet drugs. These drugs stop the formation of clots in blood vessels and reduce the size of the clots during a stroke. Commonly used antiplatelet drugs are:
- Brilinta (ticagrelor)
- Efient (Pragrell)
- Plavix (clopidogrel)
Anticoagulants (often called blood thinners) reduce the formation of blood clots. These drugs work similarly to antiplatelet drugs, but their mechanism of action is different. They are used to treat certain forms of stroke, such as those caused by atrial fibrillation (arrhythmia).
The most commonly used anticoagulants are:
- Coumarin (Warfarin)
- Eliquis (apixaban)
- Xarelto (rivaroxaban)
- Lixiana (Ndoshaban)
- Pradaxa (dabigatran)
blood pressure medication
Medications that lower blood pressure have been shown to reduce the risk of cardiovascular disease and stroke. Elevated blood pressure can cause damage to the small blood vessels in the brain.
Severely uncontrolled blood pressure can lead to transient ischemic attacks, cerebral hemorrhages, and ischemic strokes (caused by blocked blood vessels).
There are several different classes of blood pressure medications. The most commonly used drugs to control blood pressure in each category are:
Angiotensin-Converting Enzyme (ACE) Inhibitors
ACE inhibitors work on angiotensin II, a hormone that constricts blood vessels and raises blood pressure. These drugs include:
- Caperton (Captopril)
- Prinivil and Zestril (lisinopril)
- Vasotec (enalapril)
Angiotensin Receptor Blockers (ARBs)
ARBs also work against angiotensin II, which lowers blood pressure. They include:
- Atacand (candesartan)
- Cozar (losartan)
- Diovan (Valsartan)
calcium channel blockers
Calcium channel blockers lower blood pressure by relaxing blood vessels by reducing the amount of calcium flowing into them. These drugs include:
- Cardene (nicardipine)
- Norvasc (amlodipine)
- Procardia (nifedipine)
Beta blockers lower blood pressure by blocking the action of epinephrine (adrenaline) on the heart and other tissues. They include:
- Lopressor and Toprol (Metoprolol)
- Tylenol (Atenolol)
Cholesterol Drugs: Statins
Statins help lower a person’s cholesterol levels (the amount of fatty, waxy substances in the blood) and reduce the risk of future ischemic strokes. Commonly used statins are:
- Crestor (rosuvastatin)
- Lipitor (atorvastatin)
- Zocor (simvastatin)
Tissue plasminogen activator (tPA)
Tissue plasminogen activator (tPA), also known as alteplase, is used in the treatment of acute ischemic stroke to break down clots in the arteries supplying the brain. It helps restore blood flow to blocked brain areas.
Tissue plasminogen activators are very powerful agents and should only be used in certain situations. Importantly, there is a time window from stroke in which tPA is most effective. This is usually within 4.5 hours of symptoms appearing. Outside of this particular time window, tPA may do more harm than good.
Atrial fibrillation drugs
Atrial fibrillation (AFib) is an irregular heart rhythm, usually fast. This is a known risk factor for stroke, as irregular rhythms can lead to the formation of blood clots. Several medications are used to treat atrial fibrillation, including those that slow the heart rate and correct it.
Some medications to control and manage atrial fibrillation include:
- Katia (diltiazem)
- Darone (Amiodarone)
- Sotylize (Sotalol)
- Toprol (Metoprolol)
- Villarand (Verapamy)
Diabetes, a chronic disease that affects how the body uses blood sugar, is a recognized risk factor for the development of stroke. Diabetes can cause blood vessels to experience additional wear and tear over time, leading to premature aging and damage.
For these reasons, managing diabetes through proper glycemic control is a key form of stroke prevention and management.
Some medications used for diabetes are:
- Actos (pioglitazone)
- Glutathione (Metformin)
- Glynase (glibenclamide)
- Insulin (a synthetic form of the hormone made by the pancreas to regulate blood sugar)
- Januvia (sitagliptin)
- Jardiance (empagliflozin)
Medications after a stroke
Any of the aforementioned medications can be used after a stroke to help reduce the risk of future strokes. Some medicines may also be needed after a stroke to help treat conditions caused by the stroke. These include mood-boosting medications. The brain changes after a stroke, and depression is a common problem after a stroke.
Depression medications include:
- Lexapro (escitalopram)
- Prozac (fluoxetine)
- Wellbutrin (bupropion)
- Zoloft (sertraline)
You may also be taking anti-seizure medication if you have a seizure (a seizure with unstable electrical activity in the brain) after a stroke. These include:
- Capra (Levetiracetam)
- Depakote (Valproic Acid)
Stroke is a serious event closely related to cardiovascular disease. Treatment after a stroke focuses on reducing the severity of the stroke as quickly as possible while reducing the risk of future strokes. Many medications that focus on different areas of health may help reduce your future risk of stroke and cardiovascular disease.
A stroke can be a frightening and life-changing event. It’s completely normal to feel as though you’ve lost some control over your life after a stroke.Fortunately, there are many medications that can help combat risk factors and symptoms after stroke
Frequently Asked Questions
What medications are commonly used after a stroke?
One of the most commonly prescribed medications after a stroke is aspirin. Aspirin has been shown to reduce the risk of another stroke.
If you’ve taken aspirin before and experienced side effects such as severe bleeding, your doctor may recommend another drug. However, it remains one of the most commonly prescribed medications after a stroke because of its widespread use.
What medicines are prescribed after a stroke (TIA)?
After experiencing a stroke, your healthcare provider may ask you to take medication to reduce the risk of a repeat event or to develop a more severe stroke.
These medicines will depend on your other medical conditions and may include blood pressure medicines, cholesterol medicines, atrial fibrillation medicines, diabetes medicines, or a combination of these medicines.
What medicine can treat a stroke?
Stroke can be treated and in some cases reversed with the drug tissue plasminogen activator (tPA). Due to the power of tPA, it is only used in certain situations and within certain time intervals.
The use of tPA is not always necessary or appropriate for all forms of stroke.