Mild and Moderate TBI Inpatient Medications

What are our goals for our medications early in the care of the injured brain?

• Reduce the swelling of the brain
• Prevent seizures
• Treat symptoms of injury to the brain
• Prevent other complications of neurologic injury

What medications do we use for these goals?

Reducing swelling of the brain

We use a medicine or group of medicines that we often call “hyperosmolar therapy” on rounds. These medicines help pull fluid from the brain to make more room for blood as the brain swells. Most patients with mild and moderate brain injury will not actually need hyperosmolar therapy, but when the injury is in a certain place in the brain or if we have new signs of swelling in the brain, we may use one of these medications. The two most common medications that we use for swelling of the brain are 3% sodium chloride (also called hypertonic saline) and mannitol. Specific characteristics your situation will help us determine which one we might choose. Hyperosmolar medications are only used for a short time and would not be continued when you go home.

Prevent seizures

When the brain is hurt, several factors from the injury can increase the risk of seizures. Blood, swelling, and the damage itself can irritate the cells in the brain to cause these seizures, even if you have not had a seizure in the past. We can give anti-seizure medications to prevent seizures for the first week after injury. We call it “seizure prophylaxis” on rounds. At Vanderbilt, we give a drug called levetiracetam for one week for this purpose. Unless you actually have a seizure during this one-week time frame, studies tell us that continuing anti-seizure medications after seven days is not very helpful.

Treat symptoms of injury to the brain

Some patients can have headaches, difficulty with sleeping, and problems with behavior after an injury to the brain. We can give medication to help relieve the headaches if they become bothersome. In the short term, these medications could include acetaminophen, butalbital/acetaminophen/caffeine combination, sumatriptan, or another medication, depending on the specific situation. Other medications can prevent chronic headaches if they keep occurring in the following weeks to months. Several medications are used to help with sleep if difficulty falling asleep or staying asleep becomes a problem. Melatonin is a dietary supplement that may be used in some patients with brain injury. Several other medications may be chosen, depending on the exact problem. Other patients who experience agitation or have changes in behavior that cause problems after an injury may temporarily need medications to help keep them safe. These medications can include antipsychotics such as quetiapine or olanzapine. If a patient needs one of these medication, it will most likely only be for a short period of time.

Prevent other complications with neurologic injury

Patients with brain injury are at risk for other complications after their injury, including blood clots. Blood clots can happen in patients who cannot move and walk around as much as normal. To prevent blood clots, we usually start a blood thinning medication 3 days (sometimes sooner) after an injury to the brain. The blood thinner that we use could be enoxaparin or heparin at low doses. For some patients who are in the intensive care unit, we also given an anti-ulcer medication to prevent “stress-related” ulcers in the stomach. The anti-ulcer medications that we most commonly use could include famotidine, pantoprazole, or omeprazole. Not all patients will need these medications. Unless you have other injuries (like certain broken bones), you may not need these medications after you go home.

Managing Your Medications At Home

Once you are discharged, you will need to take your medicines exactly as the doctor prescribed. To make this easier, write your medicines down and the times that they are due. Make it easily visible at home so that your family can help you remember. Some people prefer to set alarms to help them remember. As time passes, the medications that you need may change. Always check with your provider if you have a question about a medication that you are taking.

Asking for help

Medications can be confusing. Never hesitate to ask questions. Our trauma pharmacist and team members will be happy to explain your medications to you so that you understand what you are getting in the hospital and why.