What are the first-line medications to treat and prevent a stroke?
Medications for stroke work in different ways. Some help prevent stroke, while others can help treat a stroke during an emergency. These medications include tissue plasminogen activators, antiplatelets, and anticoagulants.
A stroke occurs when either an artery bursts or a blockage in the arteries prevents oxygen-rich blood from reaching the brain.
When this occurs, brain cells in part of the brain can start to die off within minutesTrusted Source. The resulting damage can lead to disability and potential fatality.
Medications for stroke aim to:
- help break up blood clots
- reduce blood pressure and cholesterol levels
- help prevent blood clots
Once a person has had a stroke, they have about a 25%Trusted Source chance of having another within 5 years. This makes taking preventive steps, such as taking medications and lifestyle changes, important.
This article will provide information on the available medications to help prevent and treat a stroke.
The following table provides an overview of the medications available to treat a stroke:
| Type | Examples | Use | Potential side effects |
|---|---|---|---|
| tissue plasminogen activator (tPA) | tPA injection, or Alteplase | breaks up a clot that is causing the stroke | • bleeding • bruising • pulmonary edema • arterial embolism • deep vein thrombosis • swelling of the lips and tongue • intracranial hemorrhage • shock • nausea and vomiting • seizure • stroke • thromboembolism, a type of blood clot • sepsis |
| antiplatelets | • aspirin • dipyridamole • clopidogrel • ticagrelor |
reduce the ability of platelets in the blood to clump together | • headaches • heart palpitations • bleeding risks |
| anticoagulants | • warfarin • rivaroxaban • dabigatran • apixaban • edoxaban |
help keep the blood from clotting | • excessive bleeding • constipation • diarrhea • dizziness • indigestion • rashes • itchy skin • jaundice • hair loss • nausea and vomiting |
| statins | • simvastatin • atorvastatin • lovastatin • fluvastatin • pravastatin • pitavastatin • rosuvastatin |
help lower cholesterol | • nausea • dizziness • feeling weak • constipation • diarrhea • gas • sleep problems • headache |
| blood pressure medication | calcium channel blockers, including: • bepridil • diltiazem hydrochloride • nisoldipine • verapamil hydrochloride • felodipine • isradipine • nicardipine • amlodipine besylate • nifedipineangiotensin-converting enzyme (ACE) inhibitors, including: • trandolapril • captopril • enalapril maleate • ramipril • fosinopril sodium • lisinopril • moexipril • perindopril • quinapril hydrochloride • benazepril hydrochloride other blood pressure medications include: |
help lower blood pressure | • erection issues • headaches • tiredness or fatigue • nervousness |
To treat a stroke, a doctor may administer the tPA, called Alteplase, which can help break up a blood clot.
A doctor will likely administer tPA if a person reaches a hospital within the first 3 hoursTrusted Source of a stroke.
The medication can help improve a person’s chance of recovering from a stroke. However, many people do not reach the emergency room in time, meaning they might not be able to benefit from the medication.
Doctors administer the medication directly into the veins so that it reaches the clot quickly.
Side effects
Side effects can occur in 1–10%Trusted Source of people, the most common being bleeding. Other side effects include:
- bleeding
- bruising
- pulmonary edema, a buildup of fluid in the lungs
- arterial embolism, a type of blood clot
- deep vein thrombosis
- swelling of the lips and tongue
- intracranial hemorrhage, a bleed in the skull or brain
- shock
- nausea
- vomiting
- seizure
- stroke
- thromboembolism, a type of blood clot
- sepsis
Antiplatelet medications help prevent platelets in the blood from sticking together, which assists in preventing blood clotting.
A doctor may prescribe this type of medication to help prevent ischemic strokes or transient ischemic attacks. Ischemic strokes account for 87%Trusted Source of all cases of stroke and involve blood clots that cut off the blood supply to the brain.
A transient ischemic attack occurs when blood temporarily does not reach the brain, but the condition resolves quickly with no damage. However, they may be an early warning sign of a stroke.
Some examples of antiplatelet drugs includeTrusted Source:
- aspirin
- aspirin-dipyridamole
- clopidogrel
- ticagrelor
According to a 2019 studyTrusted Source, antiplatelet medication may have several limitations, including a lack of studies examining their long-term use, using them for acute stroke, and adherence to treatment among individuals.
A person’s doctor will assess a person’s needs and recommend dosing for the medication.
Side effects
Headaches and heart palpitations are common side effects. People may also have an elevated riskTrusted Source of bleeding eventsTrusted Source, such as intracranial hemorrhage and gastrointestinal bleeding.
Anticoagulants prevent the blood from clotting easily. A doctor may prescribe them to help prevent ischemic stroke.
Common anticoagulants includeTrusted Source:
- warfarin
- rivaroxaban
- dabigatran
- apixaban
- edoxaban
However, experts do not recommend these for everyone. People with bleeding conditions should avoid this type of medication. Those with liver or kidney issues may also want to avoid using these medications.
Side effects
The United Kingdom’s National Health Service (NHS) states that anticoagulants can lead to excessive bleeding. Signs of excessive bleeding include:
- blood in the urine
- blood in the stool
- severe bruising
- vomiting or coughing up blood
- prolonged nosebleeds, that last longer than 10 minutes
- chest pain
- difficulty breathing
- back pain
- increased bleeding during periods
Other side effects include:
- constipation
- diarrhea
- dizziness
- indigestion
- rashes
- itchy skin
- jaundice
- hair loss
- nausea and vomiting
The American Heart Association (AHA)Trusted Source notes that statins are a type of medication to help lower cholesterol. People with high cholesterol use these medications to help prevent certain liver enzymes from creating more cholesterol, lowering the chances of a blockage.
Several statins have approval for use in the United States, which include:
- simvastatin (Zocor)
- atorvastatin (Lipitor)
- lovastatin (Altoprev)
- fluvastatin (Lescol)
- pravastatin (Pravachol)
- pitavastatin (Livalo)
- rosuvastatin (Crestor)
Side effects
Statins can cause side effects, including:
- nausea
- dizziness
- feeling weak
- constipation
- diarrhea
- gas
- sleep problems
- headache
- muscle weakness
Uncommon side effects include:
- being sick
- hair loss
- hepatitis, or inflammation of the liver
- pancreatitis, or inflammation of the pancreas
In rare cases, statins can cause muscle weakness, tendon problems, and peripheral neuropathy. This is a loss of sensation or tingling in the feet and hands.
According to a 2019 studyTrusted Source, around 50% of people who start statins discontinue them due to the potential for side effects. However, the study authors also noted that the benefits, including stroke prevention, far outweigh the potential risks.
Blood pressure medication helps lower high blood pressure. High blood pressure typically shows no symptomsTrusted Source but can lead to cardiovascular events, including heart attack and stroke.
Medications for blood pressure can help prevent plaque from breaking free of the artery wall and causing a stroke.
According to a 2019 studyTrusted Source, calcium channel blockers and ACE inhibitors can help lower blood pressure and help prevent stroke.
Calcium channel blockers help preventTrusted Source the absorption of calcium in the heart. Calcium helps the heart beat with more force, which can increase blood pressure.
Examples of calcium channel blockers include:
- bepridil (Vasocor)
- diltiazem hydrochloride (Cardizem CD, Cardizem SR, Dilacor XR, and Tiazac)
- nisoldipine (Sular)
- verapamil hydrochloride (Calan SR, Covera HS, Isoptin SR, and Verelan)
- felodipine (Plendil)
- isradipine (DynaCirc and DynaCirc CR)
- nicardipine (Cardene SR)
- amlodipine besylate (Norvasc and Lotrel)
- nifedipine (Adalat CC and Procardia XL)
ACE inhibitors help block a chemical known as angiotensin, a chemical responsible for narrowing the arteries. By blocking angiotensin, the medication helps the blood flow more freely through the arteries.
Examples of ACE inhibitors include:
- trandolapril (Mavik)
- captopril (Capoten)
- enalapril maleate (Vasotec)
- ramipril (Altace)
- fosinopril sodium (Monopril)
- lisinopril (Prinivel or Zestril)
- moexipril (Univasc)
- perindopril (Aceon)
- quinapril hydrochloride (Accupril)
- benazepril hydrochloride (Lotensin)
- diuretics
Side effects
These medications can cause different side effects, including difficulty achieving and maintaining erections, fatigue, nausea, headaches, and nervousness.
Several different types of medication can help prevent stroke. They include:
- antiplatelets
- anticoagulants
- statins
- blood pressure medications, such as calcium channel blockers and ACE inhibitors
- diuretics
A person should work with a doctor to determine the best medication to help them prevent having a stroke in the future.
If a person recognizes the signs of stroke in themselves or someone they are with, they should call 911.
Paramedics can diagnose and start treating the stroke immediately. If a person seeks medical attention within 3 hoursTrusted Source of a stroke first appearing, doctors in the emergency room will likely administer an injection of tPA.
A person should speak with a doctor about how to take each medication. They should take all medication as a healthcare professional prescribes and consult a doctor before stopping any medication.
Some medications may require food, while others only need a drink to help swallow the pills. A person should read all labels carefully before taking their medications.
People who need help paying for their medications could use different financial aid options.
There are several programs exist that can help a person in need of financial assistance for medication. They can access a list of organizations to apply for help hereTrusted Source.
Often, they will need basic information, including:
- names and dosage of current medications
- monthly or yearly income
- insurance provider, if any
- state of residency
Another potential source of help could come from the doctor or pharmacy. They may be able to provide coupons to help reduce the cost or recommend cheaper generic brands as substitutes.
Medications for stroke aim to either prevent or help treat one if it occurs. Most medications aim to reduce the recurrence of stroke either by making it easier for blood to flow through the body or reducing cholesterol levels in the blood.
A person should follow all dosing and other instructions that the doctor gives them. They should also not stop taking medications without consulting a doctor first. If an individual experiences side effects, they should let the doctor know. source