How stroke medications work
There are several kinds of medications that doctors may administer or prescribe to a stroke patient: tPA, a clot buster; blood thinners; and drugs that lower high blood pressure and cholesterol.
tPA (tissue plasminogen activator)
Thrombolytic drugs such as tPA are often called clot busters. tPA is short for tissue plasminogen activator and can only be given to patients who are having a stroke caused by a blood clot (ischemic stroke). It can stop a stroke by breaking up the blood clot. It must be given as soon as possible and within 4½ hours after stroke symptoms start.* Receiving tPA can reduce the severity of a stroke and reverse some of the effects, helping you recover more quickly.
In some cases, tPA cannot be used and other treatments are required.
* In 1999, Health Canada approved the clot-busting drug called tPA to be used within 3 hours from the time stroke symptoms begin. Since that time, considerable evidence shows that tPA could be effective up to 4½ hours from the time symptoms begin. As a result, the Heart and Stroke Foundation has issued updated Canadian Stroke Best Practices Recommendations to include this longer possible treatment time. It will be up to the attending doctors to determine when tPA may be administered and if it is appropriate.
There are two kinds of blood thinners: antiplatelet drugs and anticoagulants.
When your skin is cut, platelets bind together to form a blood clot, which stops the bleeding. Similarly, when a blood vessel is injured, platelets cause blood clots to develop in the vessel. However, a clot located in an artery that is already stressed can lead to a stroke. Antiplatelet drugs help prevent platelets from sticking together and therefore prevent blood clots from forming. The most commonly used antiplatelet drug is ASA (acetylsalicylic acid, Aspirin). Your doctor can tell you if you should take ASA and how much you need to take to reduce your risk of stroke. Some people are not able to take ASA because of bleeding problems, allergies or other medical conditions. You should always talk to your doctor before taking ASA regularly to prevent stroke. Other antiplatelet drugs include clopidogrel, dipyridamole and ticlopidine.
If you are taking a blood thinner, you are at risk of bleeding more than usual if you injure yourself. Be sure to tell your doctor and dentist that you take a blood thinner.
Anticoagulants are blood thinners that prevent new blood clots from forming and keep existing blood clots from getting larger. They work by interfering with certain parts of the blood needed to form clots. They are usually prescribed for people with an irregular heartbeat (atrial fibrillation), which can cause blood clots to travel from the heart to the brain. They are commonly used in people who have had a stroke to help prevent stroke from recurring. Anticoagulant medications include:
- Heparin – given by needle at the hospital and often used after a stroke to prevent clotting. It can only be taken for a few days.
- Warfarin – a pill that can be taken for a longer period of time. It must be taken for several days before it takes effect. (While you are on Warfarin, you should be aware that some foods may interfere with its absorption – grapefruit and grapefruit juice – and effectiveness – cruciferous vegetables such as broccoli and cauliflower.) Visit Health Canada to learn more about The Effects of Grapefruit and its Juice on Certain Drugs.
Generally, people who have high blood pressure, had a recent brain injury, or are prone to falls or abuse alcohol are not prescribed an anticoagulant. If you are prescribed an anticoagulant, follow your doctor's instructions carefully. You may have to periodically have your blood tested to see how long it takes for it to clot. Try to avoid injuries because the anticoagulant may cause you to bleed more if you cut or bruise yourself. Tell all healthcare providers including your dentist that you are on anticoagulants.
Learn more about anticoagulants.
Blood pressure lowering medications
Known as antihypertensives, these medications treat high blood pressure. There are many different kinds of blood pressure-lowering drugs. Your doctor will work with you to find the drug, or combination of drugs, that is best for you. Some antihypertensives include:
- ACE (Angiotensin-Converting Enzyme) Inhibitors
- ARB’s (Angiotensin Receptor Antagonists)
- Calcium channel blockers
Cholesterol lowering medications
- Cholesterol absorption inhibitors (ezetimibe)
- Fibrates (Fibric Acid Derivatives)
How to take your medication
Some stroke medications treat stroke and some help prevent it. They all work in different ways. Some may help lower your blood pressure, reduce the level of cholesterol in your blood or help your body get rid of excess fluids that make it difficult for your heart to pump blood. Always talk to your doctor or pharmacist to find out exactly how and when to take your medication. Here are some general tips to help you take your medication properly:
Take as prescribed
Always take your medications as prescribed. Never suddenly stop taking or change them without first talking to your doctor or pharmacist.
Know what you’re taking
Be sure you know the names and dosages of the medications you are taking and a little bit about how they work. Make a list of your medications to keep with you in your purse or wallet. Before having surgery, including dental surgery, tell your doctor or dentist what medications you are taking. An antibiotic may need to be prescribed prior to your surgical or dental procedure.
Stick to a routine
If you take your medications at the same times each day, such as at lunch and dinner, it’s easier to remember when and if you took your pills. It may also help to use a pillbox (like a Dosett) marked with days of the week or have your pharmacist package your medications in blister packs.
Avoid mixing prescription medications with over-the counter drugs
If you are taking medications, do not take any over-the-counter drugs or herbal therapies without first checking with your doctor or pharmacist. Some drugs, such as antacids for stomach upset, salt substitutes, antihistamines for allergies and nonsteroidal anti-inflammatory medications for pain relief or headaches (such as ibuprofen), can worsen certain heart conditions. Avoid potentially dangerous drug interactions by telling your doctor or pharmacist about any other medication including prescription, non-prescription or natural health products such as vitamins and minerals, herbal remedies, homeopathic medicines, traditional medicines, Chinese medicines, probiotics and other products such as amino acids and essential fatty acids.
Talk to your pharmacist
If you have any questions about your medications, forget to take a dose, experience potential drug interactions or need refills, talk to your pharmacist. Also remember that your doctor is only a phone call away.
Report side effects
If a medication is causing unpleasant side effects, report them to your doctor or pharmacist. Sometimes your doctor can help you eliminate side effects simply by changing the dose, suggesting that you take the medication at a different time or using a different drug.
Eating a healthy diet that is lower in salt and fat, especially saturated and trans fats, being smoke free, limiting alcohol use, being physically active and reducing stress are also important to lowering the risk of stroke and heart disease. Talk to your healthcare practitioner about how you can achieve these lifestyle changes.
How to pay for your medication
When you are in the hospital, your provincial health plan pays for all of your medications. When you return home, however, you will have to pay for them either individually or through a provincial or private drug plan. If you need financial help to pay for your medications, you may discuss your situation with your workplace human resources department, a union representative, a social worker, a provincial or private health insurance program representative or a pharmacist.
Visit your ministry of health to learn more about the drug benefit programs in your province or territory. Visit Canadian Life and Health Insurance Association to learn more about private supplementary health insurance, which may cover some of your prescription drugs or medical expenses.
Health Canada provides health and medical information to help Canadians maintain and improve their health. Learn more about Safe Use of Medicines, Safety and Effectiveness of Generic Drugs and Buying Drugs over the Internet.
Drug Product Database provides information about drugs approved for use in Canada.
MedEffect Canada provides safety alerts, public health advisories, warnings and recalls.
Your ministry of health also provides useful health resources in your province or territory. For example, Ontario has a MedsCheck program providing free pharmacist consultations on safety use of drugs. British Columbia has a Senior Healthcare webpage providing information about important health programs.