3.3.3 Evidence for Pharmacological Measures Used to Treat Aggressive Behaviors Post TBI

What is the evidence for medications used to decrease aggressive behaviors post TBI?

Medications to Decrease Aggressive Behavior Post TBI 22

Medication

Recommended doses

Level of evidence

Recommendations

Divalproex

 

Level 4

Reduced a variety of neurobehavioural symptoms including ABI-induced agitation

Carbamazepine

400 mg -800 mg per day for 8 weeks

Level 4

Reduced agitation

Lamotrigine 

25 mg daily

Level 5

Reduced aggressive behaviour

Pindolol

60 mg -100mg/day

Level 1

Reduced aggressive behaviour

Propranolol

520 mg/day

60 mg -420 mg/day

Level 1

Reduced agitation

Methotrimeprazine

2-50 mg. 2-4 times per day

Level 4

Reduced agitation

Droperidol

2.5-5 mg IM

Level 4

Reduced agitation

Haloperidol

1-6 mg

Level 4

Reduced agitation

Quetiapine

25 to 300mg

Level 4

Reduced aggression

Sertraline HCH

50 mg- 200 mg per day

Level 4

May reduce aggressive behaviour

Amantadine

 

Level 4

For early treatment of post-TBI agitation

Trazadone

 

Level 4

For early treatment of post-ABI agitation

Lithium carbonate

 

Level 5

Reduce agitation

The ABIKUS 23was a consensus driven document; the ERABI 5dealt with the published research.  A comparison of the two is shown below:

 

ABIKUS24and ERABI22Comparison

 

Medications

ABIKUS

ERABI

Valproic Acid and Divalproex

Recommended

Level 4 evidence for Divalproex

Methylphenidate

Recommended

No evidence

SSRIs

Recommended

No evidence

Beta-blockers

Recommended

No evidence

Tricyclic antidepressants

Recommended

Level 4 evidence for Trazadone

Amantadine

No comment

Evidence is uncertain

Methotrimeprazine

No comment

Level 4 evidence

Other Anticonvulsants

No comment

Level 4 evidence for Carbamazepine

Lithium carbonate

No comment

Level 4 evidence