40 STROKECONNECTION Fall 2017
people, they can cause myopathy, but the benefit of
reducing your risk of stroke by lowering your cholesterol,
specifically your LDL, is large,” she said.
Your doctor may consider other medications, too,
especially if statins cause serious side effects or they don’t
help you enough.
Depression has been reported in as many as 33 percent
of stroke survivors, but we currently don’t have reliable
estimates for how often depression happens with stroke.
What we do know is that when stroke survivors experience
depression, it can be an obstacle to their participation in
their own recovery.
“There are neurochemical changes that can happen
Blood pressure medications
after stroke that cause depression,” Vidakovic said.
“Some patients are going to have depression and if
we treat that depression, those patients have a better
One study of fluoxetine, a selective serotonin
reuptake inhibitor (SSRI) for depression, demonstrated
that it was also helpful for motor recovery. There have
been several small studies of SSRIs that suggest this
benefit, but larger, well-controlled trials are needed to
confirm the validity of the findings. When Vidakovic
prescribes it for motor recovery, it is typically no longer
than 90 days.
High blood pressure (HBP) is a risk factor for
recurrent stroke and other cardiovascular conditions.
There are many types of HBP medicines that work in
different ways to reduce BP. It may take more than one
and several dosage adjustments before blood pressure is
“Since we typically don’t feel our blood pressure, it’s
Following the Plan
very important to monitor your blood pressure at home,”
Vidakovic said. “And take your blood pressure medications
consistently. It’s important for patients to talk to their doctor
about getting a blood pressure regimen that they can do
every day. Sometimes blood pressure is controlled with just
one medication; sometimes they may need two, three or
Vidakovic suggests using brushing your teeth as the cue
for taking HBP or diabetes medication, and she reminds us
that every increase in blood pressure increases the risk for
recurrent stroke significantly.
It is very important to take your prescriptions as directed.
These medications are prescribed in the doses and at
the times they are because the science has shown them
to work best when taken that way. Any deviation from
these instructions should always be discussed with your
healthcare provider. Don’t assume that “taking more”
will increase the effect or “taking less” will give you
the same result with fewer side effects. Never stop a
long-term medication unless advised to do so by your
Many side effects can be minimized by taking the drug
at a certain time of day, e.g. blood pressure meds taken
at bedtime, or to take advantage of the body’s circadian
rhythm. Many drugs also can be absorbed differently
if taken on an empty stomach or with food. Taking
medications as directed is important, and changing how
they are taken should never be done without consulting
your doctor or pharmacist. Learn more about some of the
side effects of common post-stroke medicines on the Stroke
Even with full understanding of the purpose and benefits
of post-stroke medications, many survivors experience
challenges taking their medicine as directed. Let’s explore
some of the main barriers people deal with, along with tips
for overcoming them.
It’s too complicated!
Stroke survivors often have to take multiple
medications, particularly if they have other conditions such
as atherosclerosis, high blood pressure or diabetes, which
may have contributed to the stroke. The more complicated
the drug or lifestyle prescription, the easier it is to miss
doses, miss refills or just simply be overwhelmed.
Solutions: Create a medication map. A medication
map is a schedule covering the whole day that plots
when you take what medicine, the dose and any other
instructions, such as whether or not to take with food. It
organizes all your medication in one place so you see at a
glance what, when and how much
Schedule a “brown bag” session with your doctor or
pharmacist. Put all your prescription and nonprescription
medications in a bag and take them to your doctor’s office
or pharmacy. They may find overlapping or duplicate
prescriptions from different doctors. This would also
be a good time to make a medication map. Periodic