Medication

A brain injury may result in an ongoing need for medications which need to be taken in the right dose, at the right time, and under the right conditions.

Possible problems with medications are an overdose, an allergic reaction, or a negative interaction with an existing medication. Medications prescribed after a traumatic brain injury can include:

• Anticonvulsants for the treatment of epilepsy
• Analgesics for pain management
• Psychotropics for the management of behaviours of concern
• Mood stabilisers and antidepressants.

It is very important to take medications as prescribed, and keep your doctor updated on all your medications and if they are working correctly or not.

Important tips to remember:

• read the instructions and follow them carefully
• don’t stop taking a medication until your doctor says to stop
• don’t use medications after their use-by date
• don’t use other people’s medications
• keep all medications out of reach of children
• give any unused medications to your pharmacist for disposal
• don’t change the dose or the time the medicine is taken.

All medications have potential side effects and it is important that these don’t worsen any of the problems a brain injury has caused.

Although it is never possible to predict which side effects a person will experience, all prescription drugs have a list of those that are most common. This information can be used to select the most appropriate medications for a patient.

Sedation, confusion, dizziness, balance disturbances, blurred vision, and tremors are examples of some fairly common medication side effects that can be particularly detrimental after a brain injury, so medication doses may be prescribed at lower rates than normal.

Newer antidepressants , such as selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and selective serotonin- norepinephrine reuptake inhibitors (SSSRIs), usually cause fewer side effects than the older ones. For example, tricyclic antidepressants (TCAs) can have high rates of side effects such as sedation, dizziness, dry mouth, confusion and constipation. Even though they are cheap and have proven effectiveness, the TCAs are rarely used if someone has a brain injury. Newer antidepressants such as sertraline (Zoloft), citalopram (Celexa), venlafaxine (Effexor XR) and others are preferred because of their better side effect profiles.

Older anticonvulsants such as phenytoin (Dilantin), phenobarbital, and primidone are usually not recommended for use after a brain injury for the same reason.

Sedation is a common effect of many medications. Although usually beneficial at night, it can be problematic when it occurs during the day and interferes with normal activities. Sedation is usually most pronounced when a new medication is started and will sometimes disappear with continued treatment. This process is due to the development of “tolerance” within the body and occurs with many medication side effects.

Drugs with strong “anticholinergic” properties can cause confusion and other types of cognitive impairment, so are best avoided after a brain injury. Examples of these include diphenhydramine (Benadryl), benztropine (Cogentin), TCAs, and many antipsychotic agents.

The primary goal with any medication is a beneficial effect with minimal side effects. First, it is important that patients taking medication have an understanding of what side effects to expect and which ones might indicate a serious problem. Since tolerance does develop to many side effects, the problem may resolve with continued treatment. The doctor may also be able to make a change in the dose or dosing schedule to minimise unwanted effects.

Sometimes a switch to another medication may be necessary. Patients must be willing to report any unusual or concerning events to their treatment provider in order for them to be addressed. Medication should never be abruptly discontinued without the doctor’s knowledge, as potentially serious discontinuation symptoms can occur with some medications.

If you don’t understand something your pharmacist or doctor says, ask them to explain in an easier way. Important questions to ask include:

• How much should I take, how often and at what times of day?
• Should I take the medicine on a full or empty stomach?
• Do I swallow the pills whole or can they be crushed or chewed?
• What should I do if I miss a dose?
• Will we reassess my need for this medication, and when?
• What are the possible side-effects and how can I manage them?
• Are there serious reactions that I need to look out for?
• Are there potentially serious interactions with other medicines?
• Do you have a brochure with information on this medication?

Use a dosette box. These plastic containers come in different shapes and sizes, and have compartments labelled by days of the week and meal times. A dosette enables you to organise the week’s medications and prevents uncertainty about whether or not a medicine has been taken.

If you take multiple medications, many pharmacists can now pre-package these for you in a Webster pack, so that a dosette box isn’t needed. Never put your medications in other bottles as it is easy to forget which ones are which.

Other points to consider:

• Check the ‘use by’ date on your medications
• Always consult your doctor if you are thinking of becoming pregnant
• Always keep medications out of children’s reach
• Get a dosette box / pill organiser to make taking medications easier
• Keep medications in their original containers in a cool dry place
• Some medicines need to be refrigerated.

Medicines Line: Call 1300 MEDICINE