TBI-AGGRESSION OR AGITATION MEDICATIONS

SUMMARY

1. Minimize use of benzodiazepines and neuroleptic antipsychotic medications.

2. Beta Blockers: recommended for the treatment of aggression after TBI. Propranolol (maximum dose 420-520 mg/day) & Pindolol (maximum dose 40-100 mg/day) may be used.

3. Anticonvulsants: carbamazepine, valproate, divalproex may be used to decrease aggression.

4. Atypical antipsychotics: Quetiapine, Olanzepine.

5. Methylphenidate: considered for anger management, particularly if they have deficits in attention and concentration.

6. SSRI: sertraline (25-200 mg/day) and paroxetine (20 mg/day) have been reported to be effective.

7. TCA: recommended as an option for the treatment if the options above are not effective. Amitriptyline and desipramine (both up to 150 mg/day).

8. Lithium: showed improvements in aggressive episodes in several case series/reports.

9. Seizure prophylaxis: valproate is preferred over phenytoin as it does not have significant neuropsychological SE in controlling seizures & stabilizing mood.

Reference(s)

Cifu, D.X. (2020). Braddom’s physical medicine and rehabilitation. Elsevier. Get it on Amazon.
Cuccurullo, S. (2019). Physical medicine and rehabilitation board review. New York: Demosmedical. Get it on Amazon.
O’Young, B., Young, M.A. and Stiens, S.A. (2008). Physical Medicine and Rehabilitation Secrets. Mosby. Get it on Amazon.