Medication side effects
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
Newer antidepressants 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
Dealing with side effects
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 minimize 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 withdrawal symptoms may
References and further information
Many thanks to The Brain Injury Resource Foundation for
permission to adapt this article from their website at