Types of Traumatic Brain Injury (TBI) Medications

Traumatic brain injury and related conditions, may require diuretics, anticonvulsants, sedatives, antidepressants, muscle relaxers, pain relievers, and stimulants to treat deficits in cognitive functions such as attention, memory, learning and language.

Traumatic brain injury (TBI) medications are administered to treat traumatic brain injuries, prevent further (secondary) injury to the brain, and manage adverse conditions that result from a traumatic brain injury.

Several classes of medications are used for emergency treatment in the immediate aftermath of a traumatic brain injury, as well as for long term management of any physiological, psychological and neurological problems arising from the TBI.

Stabilizing the patient’s vital parameters and preventing secondary injury are the immediate goals of treatment after a brain injury. Medications used during the treatment of acute phase of injury include:

• Diuretics to drain excess cerebrospinal fluid (CSF) and reduce the pressure in the brain (intracranial pressure)
• Magnesium to improve blood flow to the brain and maintain a stable state (homeostasis) in the brain
• Anticonvulsants such as gabapentin to prevent seizures from overactive neurons which are activated by the injury
• Sedative agents such as barbiturates to reduce intracranial pressure or induce a medical coma in serious brain injuries

For long-term management of TBI-related conditions, a patient may require medications such as antidepressants, muscle relaxers, pain relievers, and stimulants to treat deficits in cognitive functions such as attention, memory, learning and language.

Medications administered for traumatic brain injuries depend on the type of injury, its severity and resultant functional impairment. Medications also vary depending on the stages of treatment, which include the acute phase of treatment immediately after the injury, and long-term management of chronic symptoms.

The types of TBI medications include the following:

Acute care medications

• Osmotic diuretics
• Anticonvulsants
• Electrolytes
• N-methyl-D-aspartate (NMDA) receptor antagonists
• Barbiturates
• Calcium channel blockers

Long-term management medications

• Stimulants
• Dopamine agonists
• Selective serotonin reuptake inhibitors (SSRIs)
• Antipsychotics
• Muscle relaxers
• Pain relievers

Acute care medications

Osmotic diuretics

Osmotic diuretics work by decreasing the brain’s water content, which is drained and excreted in the urine. Osmotic diuretics are used for a short period during acute care to reduce the edema and intracranial pressure. Osmotic diuretic used for TBI treatment is:

• Mannitol (Osmitrol, Resectisol)

Anticonvulsants

Anticonvulsant medications are administered to prevent seizures. TBI can result in excessive release of brain chemicals (neurotransmitters) which overstimulate the neurons resulting in seizures and secondary injury to the brain. Anticonvulsants used in TBI treatment include:

• Phenytoin (Dilantin, Phenytek)
• Valproate sodium
• Gabapentin (Neurontin)
• Topiramate (Topamax)
• Carbamazepine (Equetro)

Electrolytes

Traumatic brain injury can lower electrolyte levels which can adversely affect heart function and blood pressure. Magnesium improves blood flow to the brain and also plays a role in preventing overstimulation of the neurons by inhibiting an excitatory neurotransmitter known as glutamate. Electrolytes administered after a TBI include:

• Magnesium sulfate (NMDA)
• Potassium
• Phosphate

N-methyl-D-aspartate (NMDA) receptor antagonists

N-methyl-D-aspartate (NMDA) receptor antagonists reduce the hyperactivity of neurons and prevent secondary injury to the brain. Glutamate and another excitatory neurotransmitter known as aspartate, both of which are released after an injury, stimulate the NMDA receptors causing abnormal neuronal activity.

NMDA receptor antagonists block the activity of NMDA receptors. NMDA receptor antagonist commonly prescribed after a TBI is:

• Dextromethorphan/quinidine (Nuedexta)

Barbiturates

Barbiturates which have sedative and anticonvulsant properties may be administered if other methods to lower the intracranial pressure are not effective. Barbiturates may also be administered to induce a medical coma in patients with severe brain injury. Barbiturates used in TBI treatment include:

• Pentobarbital sodium (Nembutal sodium)

Calcium channel blockers

Calcium channel blockers help prevent blood vessel spasms and maintain blood supply to the brain. Calcium channel blockers have been found to be useful in preventing secondary damage after subarachnoid hemorrhages. The commonly used calcium channel blocker in TBI treatment is:

• Nimodipine (Nymalize)
• Long-term management medications

Stimulants

Stimulants help improve some aspects of cognitive functions such as alertness and attention, by increasing the levels of neurotransmitters such as norepinephrine and dopamine. Stimulants used in TBI treatment include:

• Methylphenidate hydrochloride (Ritalin, Daytrana)
• Modafinil (Provigil)

Dopamine agonists

Dopamine agonists stimulate the release of dopamine which helps improve alertness. An example of dopamine agonist used in TBI treatment is:

• Levodopa

Selective serotonin reuptake inhibitors (SSRIs)

SSRIs increase the level of serotonin, a neurotransmitter that regulates mood. SSRIs are administered to treat emotional disturbances that can occur after a TBI. Examples of SSRIs used in TBI include:

• Sertraline hydrochloride (Zoloft)
• Citalopram hydrobromide (Celexa)
• Paroxetine hydrochloride (Paxil)

Antipsychotics

Antipsychotic medications are prescribed to treat psychosis and other mental conditions that can result from a TBI. A commonly prescribed antipsychotic medication is:

• Quetiapine fumarate (Seroquel)

Muscle relaxers

Muscle relaxers are used to relax muscle cramping and tightening because of injury to motor neurons in the brain. Commonly prescribed muscle relaxers include:

• Tizanidine hydrochloride (Zanaflex)
• Baclofen (Lioresal)
• Dantrolene sodium (Dantrium)
• Diazepam (Valium, Diazepam Intensol)
• Cyclobenzaprine hydrochloride (Amrix)

Pain relievers

Pain relievers used for management of pain from TBI include:

• Acetaminophen (Tylenol)
• Ibuprofen (Advil, Motrin)
• Naproxen sodium (Naprosyn, Aleve, Anaprox DS)

Your doctor should be consulted about the best choice of pain medicine to use, depending on the type of TBI. Some pain medicines may exacerbate bleeding in the brain.

• Please visit our medication section of each drug within its class for more detailed information.
• If your prescription medication isn’t on this list, remember to look on MedicineNet.com drug information or discuss with your healthcare provider and pharmacist.
• It is important to discuss all the drugs you take with your doctor and understand their effects, possible side effects and interaction with each other.
• Never stop taking your medication and never change your dose or frequency without consulting with your doctor.

An injury from a blow or jolt to the head which impairs normal functions of the brain is considered a traumatic brain injury. Traumatic brain injuries can cause bruising and bleeding in the brain, damage brain cells, cause swelling (edema) in the brain, and release large quantities of neurochemicals which can be toxic to the brain.

Traumatic brain injuries are primarily classified as:

• Penetrating injury in which something penetrates the skull and injures the brain.
• Non-penetrating or blunt injury in which a blow to the head, or a jolt such as a whiplash, which may knock the brain against the inside of the skull.

A traumatic brain injury may be mild, moderate or severe (also termed grade 1, 2 and 3). Mild TBIs, also known as concussions, are usually not life-threatening, and symptoms often last for only a short period. However, researchers suggest multiple concussions may be responsible for some chronic brain changes. Severe head injuries may cause lasting damage to the brain, disabilities, coma or death.

Traumatic brain injuries may be focal, in a small specific area, or diffuse injury over a large area of the brain, which may not be apparent on a CT scan, but causes TBI symptoms.

Types of traumatic brain injuries include the following:

• Hematoma: A hematoma is a blood clot that forms inside or on the surface of the brain after an injury.
• Contusion: Contusions are areas of bruising, with injured brain tissue and blood that has leaked out of tiny blood vessels.
• Hemorrhage: Hemorrhage is uncontrolled bleeding in any part of the brain, which may be of two types:
• Subarachnoid hemorrhage: Bleeding in the space around the brain.
• Intracerebral hemorrhage: Bleeding within the brain tissue.
• Diffuse axonal injury: Axons are long, hair-like projections from nerve cells (neurons), which enable communication between nerve cells and make the body function. Diffuse axonal injury is one of the most dangerous types of TBI because it can cause severe and lasting disabilities.
• Ischemia: Ischemia is inadequate blood supply to parts of the brain, because of injury.
• Skull fractures: Skull fractures may be simple cracks in the skull or fragments of skull that push into the brain, damage brain tissue, blood vessels and nerves, and cause leakage of the cerebrospinal fluid.

Symptoms may vary depending on the severity of injury. Symptoms of a mild TBI include:

• Headache and neck pain
• Dizziness
• Blurry vision
• Ringing in the ears
• Confusion
• Nausea
• Brief loss of consciousness

In addition to the above symptoms which may continue to last, a moderate to severe traumatic brain injury may cause any of the following symptoms:

• Vomiting
• Leakage of cerebrospinal fluid from the ears or nose
• Loss of balance and coordination
• Loss of muscle control
• Dilated pupils and vision problems
• Speech difficulty
• Breathing problems
• Memory loss and other cognitive problems
• Change of mental state
• Loss of consciousness
• Muscle stiffness (spasticity)
• Paralysis
• Coma

Leading causes for traumatic brain injuries include the following:

• Motor vehicle accidents
• Falls, particularly in aged persons and children
• Violent assaults and abuse
• Sports injuries
• Explosions
• Gunshot wounds

The treatment for a traumatic brain injury depends on the severity of the injury. A mild injury may need no more than pain relievers and rest for the symptoms to resolve. It is important, however, to watch if any of the symptoms persist, and if so, consult a doctor.

Severe TBIs require rapid assessment of the injury and the patient’s condition to determine the appropriate treatment. Doctors commonly use a clinical assessment scale known as Glasgow Coma Scale to evaluate the patient’s consciousness level based on their response.

Depending on the type of injury, emergency treatment for a moderate to severe traumatic brain injury may include:

• Steps to stabilize the patient’s blood circulation and breathing, control blood loss, reduce intracranial pressure and prevent secondary injury
• Surgery to remove hematomas, reduce intracranial pressure, and remove bone fragments in the case of a complicated skull fracture

Treatment to manage long-term symptoms and complications that result from a TBI include:

• Medications
• Rehabilitation therapies such as:
  • Physical therapy
  • Occupational therapy
  • Speech therapy
  • Cognitive therapy
  • Emotional counseling