After an initial stroke, 1 in 4 individuals will have another within five years. Medications play an important role in preventing another stroke and treating stroke-related complications, often in tandem with lifestyle changes.

There’s no one-size-fits-all treatment plan. Your doctor may prescribe one or more medications based on the underlying cause of your stroke as well as its impact on your physical and mental health.

Here’s what to know about stroke causes and medications commonly prescribed during recovery.

Causes and symptoms of a stroke

A stroke disrupts the flow of blood and oxygen to the brain, potentially damaging brain tissue. This can lead to impaired speech, impaired cognitive function, memory loss, numbness, and paralysis.

Strokes can be life-threatening, so it’s important to seek immediate medical care if you exhibit signs of a stroke such as the following:

• Sudden numbness or weakness in the face, arm, or leg

• Sudden confusion or difficulty speaking or understanding speech

• Suddenly impaired vision

• Sudden loss of balance or coordination

• Sudden dizziness

• Sudden severe headache without another cause

There are two types of strokes, with different underlying causes:

• An ischemic stroke occurs when blood flow to the brain is blocked, often due to a blood clot or the accumulation of plaque in blood vessels. It is the more common type of stroke. Associated health risk factors include high cholesterol, atrial fibrillation, and diabetes.

• A hemorrhagic stroke occurs when a blood vessel in the brain leaks or ruptures, damaging brain cells as a result. Associated health risk factors include high blood pressure and aneurysms.

Additionally, a transient ischemic attack (TIA) — sometimes referred to as a ministroke — occurs when there is temporarily reduced or blocked blood supply to the brain, often as the result of a blood clot. Unlike ischemic and hemorrhagic strokes, a TIA does not result in permanent damage.

Many of the leading risk factors for a stroke are modifiable, including:

• High blood pressure

• History of heart disease

• Diabetes

• High cholesterol

• Obesity and lack of exercise

• Smoking

• Heavy alcohol use

• Drug use

Aftercare may include management of these risk factors.

Medications prescribed after a stroke

There are a variety of medication classes used during stroke recovery, including the following.

Blood pressure medications

Since high blood pressure is a leading cause of hemorrhagic strokes, stroke recovery may involve the use of several types of blood pressure medications.

• Beta blockers cause the heart to beat more slowly and less forcefully, lowering blood pressure. Commonly prescribed beta blockers include atenolol (Tenormin®), bisoprolol (Zebeta®), metoprolol tartrate (Lopressor®), metoprolol succinate (Toprol-XL®), acebutolol (Sectral®), and propranolol (Inderal®).

• ACE inhibitors lower blood pressure by blocking production of a hormone called angiotensin II, which causes blood vessels to narrow. Commonly prescribed ACE inhibitors include benazepril (Lotensin®), enalapril (Vasotec®), fosinopril (Monopril®), lisinopril (Prinivil®, Zestril®), and ramipril (Altace®).

• Calcium channel blockers prevent calcium from entering the smooth muscle cells of the heart and blood vessels so that the heart beats with less force. Commonly prescribed calcium channel blockers include amlodipine (Norvasc®), diltiazem (Cardizem CD®, Tiazac®), nifedipine (Procardia XL®), and verapamil (Calan SR®, Verelan®).

• Diuretics lower blood pressure by helping the body get rid of excess sodium and water, reducing the volume of fluid in blood vessels. Commonly prescribed diuretics include chlorthalidone (Thalitone®, Tenoretic®, and Clorpres®), hydrochlorothiazide (HydroDiuril®, Microzide®, and Esidrix®), and indapamide (Lozol®).

Read Common Types of Blood Pressure Medications to learn more about these medications and potential side effects.

Anticoagulants

Anticoagulants interrupt the body’s natural blood clotting process to prevent new clots from forming and existing ones from growing. The following types of anticoagulants may be prescribed after an initial ischemic stroke.

• Warfarin (Coumadin® and Jantoven®) prevents your liver from producing proteins that help form blood clots. It is taken orally as tablets. It has been associated with excessive bleeding in some individuals. Inform your doctor if you have a bleeding disorder so that they can prescribe an alternative.

• Direct-acting oral anticoagulants (DOACs) directly block the blood’s ability to form new clots. Commonly prescribed DOACs include apixaban (Eliquis®), dabigatran (Pradaxa®), edoxaban (Savaysa®), and rivaroxaban (Xarelto®).

Read How Anticoagulants Prevent Blood Clots From Forming to learn more about these medications and potential side effects.

Antiplatelets

Like anticoagulants, antiplatelets prevent blood clotting and may be used during recovery from an ischemic stroke. They prevent platelets from coalescing, targeting a particular step in the formation of blood clots. Clopidogrel (Plavix®) is a commonly prescribed antiplatelet during stroke recovery.

Aspirin may also be used for antiplatelet therapy. If you are taking aspirin, avoid taking other nonsteroidal anti-inflammatories (NSAIDs) like ibuprofen and naproxen, as they may interfere with aspirin’s antiplatelet effect.

Atrial fibrillation medications

Atrial fibrillation, or Afib, is a rapid heart rate caused by irregularities in the heart’s upper chambers. It can lead to the accumulation of blood and the formation of blood clots, increasing an individual’s risk for stroke. (Having other conditions such as high blood pressure, diabetes, or heart failure in addition to Afib may further increase your risk for a stroke.)

There are several medications that may be used to control heart rate and prevent a secondary stroke, including beta blockers, calcium channel blockers, and an antiarrhythmic called digoxin (Digox®, Lanoxin®, Digitek®).

Statins

Since high cholesterol may be associated with an increased risk for an ischemic stroke or ministroke, statins — a type of cholesterol-lowering medication — may be prescribed during stroke recovery. Statins act on the liver to reduce the amount of cholesterol produced by your body, in turn preventing plaque accumulation.

Commonly prescribed statins include atorvastatin (Lipitor®), fluvastatin (Lescol®), lovastatin (Mevacor®, Altoprev®), pravastatin (Pravachol®), rosuvastatin calcium (Crestor®), and simvastatin (Zocor®).

Read How to Manage High Cholesterol: Diet, Medications, and More to learn more about these medications and potential side effects.

Diabetes treatment

If you have diabetes, your doctor may revisit your diabetes treatment plan after an ischemic stroke. Individuals with type 1 diabetes require insulin every day to maintain healthy blood sugar levels. Treatment for type 2 diabetes is more varied and may involve insulin, oral medications such as metform, or a combination of both.

Osteoporosis treatment

A stroke may lead to the loss of bone density. This can increase an individual’s risk for osteoporosis, a condition that weakens bones. After a stroke, your doctor may recommend increasing your intake of calcium and vitamin D — the most important nutrients for bone strength and health — depending on your symptoms.

Treatment for osteoporosis may also include medications such as bisphosphonates, which prevent the loss of bone mass. Commonly prescribed bisphosphonates include alendronate (Fosamax®, Binosto®), ibandronate (Boniva®), risedronate (Actonel®, Atelvia®), and zoledronic acid (Reclast®).

Antidepressants

Many individuals experience depression after a stroke, both as a response to the emotional challenges of stroke recovery and due to stroke-induced biochemical changes in the brain.

Medication may be necessary to manage symptoms of depression. There are many types of antidepressants, including:

• Selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac®), sertraline (Zoloft®), citalopram (Celexa®), and escitalopram (Lexapro®)

• Serotonin and norepinephrine reuptake inhibitors (SNRIs) such as duloxetine (Cymbalta®), venlafaxine (Effexor®), and desvenlafaxine (Pristiq®)

• Atypical antidepressants such as trazodone, mirtazapine (Remeron®), and bupropion (Wellbutrin®)

A psychiatrist can recommend the best option based on your particular symptoms of depression, your overall health history, and other medications you’re taking.

Other components of stroke recovery

Recovery from a stroke is often a gradual process. In addition to taking medication and practicing a healthy lifestyle, your doctor may also recommend speech therapy, physical therapy, and/or occupational therapy.

It’s important to take care of your emotional and mental health. Speak with your healthcare provider about resources that can support your recovery and help you adjust to the changes a stroke may bring. Individual psychotherapy or support groups can be helpful tools.

Let Alto support your stroke recovery

At Alto, we make it as simple as possible to follow the treatment plan your doctor recommends. We will work with your doctor, your insurance (if applicable), and any third party savings programs that you may qualify for to ensure your medications are as affordable as possible. And our team of pharmacists is available to chat whenever questions come up about side effects or how to take your medication properly.

Reach out any time through in-app messaging or by phone at 1-800-874-5881.

This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition.

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