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.
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.
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.
Anticoagulants help keep the blood from clotting. They make clots harder to form or slow them from growing. Warfarin and heparin are common examples. There are also medicines called direct oral anticoagulant and these include: Apixaban (Eliquis), dabigatran (Pradaxa), edoxaban (Lixiana, Savaysa), rivaroxaban (Xarelto). 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
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.
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.
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 citalopram (Celexa), fluoxetine (Prozac, Rapiflux), paroxetine (Brisdelle, Paxil, Paxil CR, Pexeva), or sertraline (Zoloft).
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 botulinum toxin (Botox) in the affected muscle. They might also prescribe pills to relieve spasms and cramping.