3.3.4.13 Medication Management for Behavioural Issues Post ABI

  • Although several medications have been given to reduce agitation, aggression and depression following an ABI, there is little quality research done examining the effectiveness of these medications. 
     
  • Pharmacological management of episodic behavioural and emotional dyscontrol may include: anticonvulsants, methylphenidate, serotonin reuptake inhibitors (SSRI), beta-blockers, and tricyclic antidepressants24. The following table includes a list of medications that have been investigated 43.
     

 

Medications given to reduce behavioural issues post ABI

 

Medication given to address behavioural issues post ABI

Reason

Amount Given

Effect

Levels of Evidence

Amantadine 46;50

To improve behaviour and cognitive functioning post ABI

 

Amantadine was not found to be effective in treating agitation post injury.

Level 2

Carbamazepine 51

To treat aggressive behaviour post ABI

Mean dose 9.47 ±2.9 mg/kg/day of carbamazepine was given for 8 weeks

Not shown to be effective in treating agitation following an ABI.

Level 4

Lamotrigine 52;53

Case study lamotrigine was given as a mood stablizer

Doses ranged from 125 mg daily to 300 mg daily. Lamotrigine was also given in combination with other medications

Lamotrigine was found to assist in reducing unwanted behaviours such as verbal aggression.

Level 5

(Limited)

Valporic Acid 28

Valporic acid post injury used to reduce challenging behaviours

5 patients were given valporic acid.  750 mg to 1500 mg was given daily along with a valporic acid serum concentrate of 35 to 110ug/ml to was also administered.  Doses varied with each patient.

Valproci acid was found to decrease the incidence of aggressive behaviours post injury

Level 5

(Limited)

Divalproex 30

Divalproex was given to reduce agitated behaviour (biting, profanity, punching etc)

A mean daily dose of 1257mg of divalproex was given to patients

The incidence of aggressive behaviours was decreased

Level 4

Although there is some evidence to support using anticonvulsants to address aggressive behaviours post ABI, more research needs to be done to understand their effectiveness.

Medication given to address behavioural issues post ABI

Reason

Amount Given

Effect

Levels of Evidence

Sertraline 38;42

To reduce aggression and irritation post injury.

Sertraline HCL was given to patients- up to 200 mg daily up to 8 weeks.

Amitriptyline was given for 8 weeks.

A decrease in aggressive behaviour was found following the administration of the medication.

Level 4

Pindolol 34

 

To improve behaviours following an ABI.

Subjects received 60 mg daily of pindolol daily for 10 days; medication was then increased to 100 mg in an attempt to see which dose would be more effective.

Pindolol was found to decrease aggressive behaviour following post injury.

Level 1

Propranolol 35

To reduce agitation.

Medication began at 60 mg daily and was increased by 60 mg per every 3 days to 420 mg

Propranolol was found to reduce agitated symptoms post injury.

Level 1

Buspirone 54

To reduce agitation and anxiety.

Patient began taking 5mg 3x/day of buspirone but after 2 days this was increased to 10mg 3x/day.

Buspirone may be effective in reducing symptoms of agitation post ABI

Level 5

(Limited)

Quetiapine 55

To treat aggressive behaviours post ABI

The amount of medication given ranged from 25 to 300 mg daily

Quetiapine was found to reduce aggressive behaviours but due to the small sample size (n=7) more research is needed.

Level 4

Ziprasidone 56

To decrease agitation.

Medication ranged from 20mg/day to 80mg/day. Patients were on medication for a period of 35 to 68 days.

Aggression and disinhibition scores on the Agitated Behavior Scale decreased within the first 14 days of patients being put on the medication

Level 4

Lithium Carbonate 57;58

To stabilize mood as it is believed that mood disorders may lead to aggressive behaviors

Dose varied depending on the patient.

Aggressive behaviors decreased without any evidence of a decrease in cognitive or motor behavior

Level 5

(Limited)

Medication given to address behavioural issues post ABI

Reason

Amount Given

Effect

Levels of Evidence

Medroxyprogesterone59

Sexually disinhibited behaviour

400 mg given 1 x per week, along with monthly psychoeducational counseling

Given intramuscularly was found to reduce sexual aggression

Level 4

Methotrimeprazine47

To reduce agitation

2-50 mg was administered up to 4 x daily

Was felt to be safe and effective in controlling agitated behaviour.

Level 4

Methylphenidate37;60

To control anger post injury

In 2 studies methylphenidate was administered post injury: to assess its effectiveness in treating processing speed, work task attentiveness and reducing anger. 

Methylphenidate may be effective in increasing speed and in reducing anger post injury

Level 1

Level 2

Droperidol61

To assist in calming agitated behaviour post injury

Single dose given intramuscularly (1.25 to 10 mg) for episodes of acute agitation.

Time to achieve calming was 27 minutes following an injection of droperidol compared with haloperidol, lorazepam or diphenhydramine.  

Level 4

 

Haloperidol49

To assist with the reduction of agitation

2 to 15 mg/day of haloperidol was given for 14 to 62 days.

Haloperidol was not found to have a negative effect on the success of rehabilitation.

Level 4