Stroke Recovery: Medications to Stay Healthy and to Prevent Another Attack https://www.webmd.

com/stroke/meds-after-stroke

What Meds Do You Need to Take

After a Stroke?
By Barbara Brody
 Medically Reviewed by Melinda Ratini, DO, MS on February 20, 2020

If you’ve had one stroke, you have about a 25%-35% chance of having a second
one. Your doctor will use medication to lower those odds.

They’ll want to make sure you control your high blood pressure. You also may
need to start or stay on blood thinners , or take drugs to treat any underlying
heart problems.

The exact mix of medication will depend on which types of stroke you had:

• Ischemic strokes are caused by a clot in an artery that supplies blood to

your brain.

• Hemorrhagic strokes happen when you have bleeding inside your brain
 as a result of a ruptured blood vessel.

• Transient ischemic attacks (TIAs) aren't strokes, but they're a warning that
you could have one later. TIAs don't last as long as ischemic strokes and go
away on their own.

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Blood Pressure Drugs

High blood pressure, also called hypertension , is a top cause for both types
of stroke. So it’s a good bet you'll need medication to bring your readings down.
Common treatments work in different ways:

Diuretics, sometimes called water pills, help your body flush out extra salt and
fluids. You might take them with other blood pressure drugs. Diuretics can
lower potassium levels, which can lead to weakness, leg cramps, and fatigue.
Eating lots of foods that are high in potassium (like banana, spinach, and sweet
potato) may prevent these symptoms. Your doctor may also recommend a
potassium supplement if needed.

ACE inhibitors relax and widen your blood vessels. This helps the blood flow
more easily.

Beta-blockers stop the effects of a hormone called adrenaline, so your heart

beats with less speed and pressure. You usually won’t take these until you’ve
tried diuretics or other blood pressure drugs.

Calcium channel blockers help your blood vessels relax and open up by
blocking calcium from entering the cells in the heart and blood vessels. They
also can slow your heart rate, which lowers blood pressure.

Angiotensin II receptor blockers make it easier for your heart to pump by

blocking a chemical that narrows blood vessels.

SUGGESTED

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Anti-Clotting Drugs

If you had an ischemic stroke , you’re almost certain to take a drug to prevent
future blood clots.

Surprisingly, you might get this type of medication even if you had a bleeding
stroke. Your doctor may recommend this to help prevent an ischemic stroke or a
blood clot in the lungs. Your doctor will weigh your personal odds of blood clots
vs. bleeding.

Anticoagulantshelp keep the blood from clotting. They make clots harder to
form or slow them from growing. Warfarin and heparin are common examples.
Anticoagulants are aggressive drugs. You usually take them if your chance of
stroke is high or if you have an irregular heartbeat condition called atrial
fibrillation (AFib).

Antiplatelets also prevent clots from forming by keeping cells called platelets
from sticking together. Aspirin is the best-known example. You might have to
take aspirin or other types of antiplatelets for the rest of your life if you’ve had
an ischemic stroke or a TIA.

Both types of anti-clotting drugs raise your chances of bleeding. They also can
cause problems for people with ulcers. People on certain blood thinners , such
as warfarin (Coumadin, Jantoven), need to be consistent when eating
cauliflower, broccoli, and leafy greens because they contain vitamin K, which
can make the drug less effective. Eating about the same amount of these foods
every day helps keep the levels of medication in the blood stable.

Atrial Fibrillation Drugs

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If you have this irregular heartbeat condition, you’re 5 times more likely to have
a stroke than other people. AFib makes blood pool in your heart, where clots
can form. You usually need to take (or stay on) anti-clotting medications, like
aspirin or warfarin. But you also may take drugs to control your heart rate or
rhythm.

Heart rate drugs. You take these to keep your heart from beating too quickly.
One way is with blood pressure medication, like a beta-blocker or calcium
channel blocker. Another choice is digoxin (Cardoxin, Digitek, Lanoxin), which
slows the speed of electrical currents as they travel through your heart.

Heart rhythm drugs. Once you restore a normal heartbeat (pulse), you may
take drugs to control your heart's rhythm (like skipped or extra beats). You may
need a sodium channel blocker -- like quinidine, flecainide (Tambocor), or
propafenone (Rythmol) -- which slows the heart’s ability to conduct electricity.
Potassium channel blockers -- like sotalol (Betapace, Sorine) and amiodarone
(Cordarone, Pacerone) -- work similarly by slowing the electrical signals that
cause atrial fibrillation, or AFib.

SUGGESTED

Cholesterol Drugs

After a stroke, your doctor will likely give you a cholesterol-lowering medication
called a statin. That's because statins seem to lower the risk of a second
stroke. You might take them even if your LDL, or “bad” cholesterol , is already
lower than 100 mg/dL and you have no other signs of narrowed blood vessels.

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Diabetes Drugs

If you don’t already know you have type 2 diabetes, you’ll probably get
screened for it and prediabetes after your stroke. If your blood sugar levels are
too high, the doctor might prescribe medication to control them. Some help
your body produce more insulin . Others slow the rate at which
carbohydrates break down in your bloodstream.

Meds for Post-Stroke Conditions

A stroke can leave you with new medical issues during your recovery. That can
depend on the type of attack you had, how severe it was, and how you respond
physically and emotionally.

Antidepressants: Depression and anxiety are common after a stroke. One often
prescribed antidepressant type is a selective serotonin reuptake inhibitor.
Examples are sertraline (Zoloft), citalopram (Celexa), paroxetine (Brisdelle,
Paxil, Paxil CR, Pexeva), or fluoxetine (Prozac, Rapiflux).

Drugs for central pain: You might have burning or aching in your body after a
stroke. Your doctor may suggest amitriptyline, an antidepressant, or
lamotrigine, an anti-seizure drug.

Osteoporosis supplements: You often lose lean muscle and bone density after
a stroke. That makes you more likely to get osteoporosis. Your doctor may
suggest you take calcium and vitamin D supplements and possibly a medication
to keep your bones strong.

Muscle spasm drugs. A stroke may leave you with muscle movements you can’t
control. Your doctor will call this spasticity. They may give you a shot of

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botulinum toxin (Botox) in the affected muscle. They might also prescribe pills
to relieve spasms and cramping.

Show Sources
SOURCES:

American Heart Association: "Atrial Fibrillation Medications," "Types of Blood Pressure Medications." 

American Stroke Association: "Anti-Clotting Agents Explained," "Treatment: Recovery and Risk Reduction to Prevent
a Second Stroke."

CDC: "Types of Stroke."

Harvard Heart Letter: "New Guidelines for the Prevention of Recurrent Stroke."

Stroke: "Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack," "Guidelines
for Adult Stroke Rehabilitation and Recovery, A Guideline for Healthcare Professionals From the American Heart
Association/American Stroke Association."

National Health Service: “Stroke: Treatment.”

UpToDate: "Patient education: Hemorrhagic stroke treatment (Beyond the Basics)."

Mayo Clinic: “High blood pressure (hypertension),” “Diabetes treatment: Medications for type 2 diabetes.”

National Stroke Association: “Preventing Another Stroke.”

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