Intracranial Hemorrhage Medication

Updated: Oct 13, 2017
  • Author: David S Liebeskind, MD, FAAN, FAHA, FANA; Chief Editor: Helmi L Lutsep, MD  more...
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Medication

Medication Summary

Antihypertensive agents reduce blood pressure to prevent exacerbation of intracerebral hemorrhage. Osmotic diuretics, such as mannitol, may be used to decrease intracranial pressure.

As hyperthermia may exacerbate neurological injury, acetaminophen may be given to reduce fever and to relieve headache.

Anticonvulsants are used routinely to avoid seizures that may be induced by cortical damage. Levetiracetam has shown efficacy in children for prophylaxis of early posthemorrhagic seizures. [13] Additional data suggest that levetiracetam is more effective than phenytoin for seizure prophylaxis without suppression of cognitive abilities in patients with ICH. [14] Vitamin K and protamine may be used to restore normal coagulation parameters. Antacids are used to prevent gastric ulcers associated with intracerebral hemorrhage.

Accumulating data suggest that statins have neuroprotective effects; however, their association with intracerebral hemorrhage outcome has been inconsistent. [16] Antecedent use of statins prior to intracerebral hemorrhage is associated with favorable outcome and reduced mortality after intracerebral hemorrhage. This phenomenon appears to be a class effect of statins.

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Antihypertensive agents

Class Summary

These agents reduce blood pressure to prevent exacerbation of intracerebral hemorrhage.

Labetalol (Normodyne, Trandate)

Antagonizes adrenergic receptors, thereby reducing blood pressure.

Nicardipine (Cardene, Cardene SR)

Calcium channel blocker. Potent rapid onset of action, ease of titration, and lack of toxic metabolites. Effective but limited reported experience in hypertensive encephalopathy.

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Osmotic diuretics

Class Summary

Osmotic diuretics reverse pressure gradient across the blood-brain barrier, reducing intracranial pressure.

Mannitol (Osmitrol, Resectisol)

Reduces cerebral edema with help of osmotic forces and decreases blood viscosity, resulting in reflex vasoconstriction and lowering of intracranial pressure.

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Antipyretics, analgesics

Class Summary

These agents reduce fever and relieve pain.

Acetaminophen (Tylenol, Feverall, Aspirin Free Anacin)

Reduces fever, maintains normothermia, and reduces headache.

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Anticonvulsants

Class Summary

These agents reduce the frequency of seizures and provide seizure prophylaxis.

Fosphenytoin (Cerebyx)

Diphosphate ester salt of phenytoin that acts as water-soluble prodrug of phenytoin. Following administration, plasma esterases convert fosphenytoin to phosphate, formaldehyde, and phenytoin. Phenytoin in turn stabilizes neuronal membranes and decreases seizure activity.

To avoid need to perform molecular weight-based adjustments when converting between fosphenytoin and phenytoin sodium doses, express dose as phenytoin sodium equivalents (PE). Although can be administered IV and IM, IV route is route of choice and should be used in emergency situations.

Concomitant administration of IV benzodiazepine usually necessary to control status epilepticus. Full antiepileptic effect of phenytoin, whether given as fosphenytoin or parenteral phenytoin, not immediate.

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Antidotes

Class Summary

This agent reverses some coagulopathies or bleeding diatheses.

Phytonadione; vitamin K (Konakion, Mephyton, AquaMEPHYTON)

Promotes hepatic synthesis of clotting factors that inhibit warfarin effects.

Protamine

Forms a salt with heparin and neutralizes its effects.

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Antacids

Class Summary

These agents provide prophylaxis of gastric ulcers.

Famotidine (Pepcid)

Minimizes development of gastric ulcers.

Competitively inhibits histamine at H2 receptor of gastric parietal cells, resulting in reduced gastric acid secretion, gastric volume, and hydrogen concentration.

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