Questions about post-stroke prescriptions

[mghdi1120]

My husband Brian is recovering from a stroke secondary to a coratid tear.  His BP upon arrival in the ER on 4/24 was 190/95.  He had not seen a dr. in 10 years except for one check up I insisted on when we first got married 18months ago.  He was hospitalized for 9days and rehabbed in patient for 2 1/2 wks.  He is now walking and talking and pretty well balanced after total initial left side paralysis.  Thank God!  He came home on Thursday 5/23 with scripts for 5mg. Coumadin daily, 500mg Keppra 2x a day for siezures.  The Nuero at the rehab read his tests and said that it was unclear whether or not Brian had ever siezured. I want to stop the Keppra. the pcp  says that no one wants to make the call whether he really siezured or not or whether he might.  We asked if WE could. Doc said we could.  We reduced him from 1000mg per day to 750 as of 5/25.  If it were me I'd drop it in one shot.  Is it true that He either needs it because he did and could siezure or he does not because he did not and won't.  At 250 reduced every 2wks he will be on it for 6 more weeks... Safer?? necessary? Advised? No headaches whatsoever by the way.  He was unable to urinate for 3wks, tried a 12 hour stint off the Catheter at the 12day mark, no good, recathed.  HE's on Flomax and has been fine for 8days.  Brian was encourage to take an anti-depressant which he refused.  They asked me to encourage him and to ok it.  I refused.  Upon discharge we learned that Brian had been put on 10mg Lexapro anyway.  He stopped taking it at discharge. He is on hydrochlorothiazide 12.5mg daily (this appears to be contraindicated with the keppra???) and 10mg every 12hours Lisinopril.  Brian bottomed out in the hospital on day 8ish -naseated, pale, clammy and then passed out with a BP of 75/50.  This was 12 hours after I had a bitey conversation with the cardio that he was on too many meds that lower the bp too much for him to recover. His doses were lowerd.  Last night (SAT 26) Brian bottomed out in the bathtub.  Same thing, nausea, white as a ghost, collapsed while trying to get out of the tub, passed out.  He is 204lbs, this was scary.  TOO many drugs with too many side affects.  He is able to sustain an erection but not able to orgasm.  He believes that this is the flomax and wants to discontinue it and go to 2000mg Saw Palmetto.  We will do some homework on the prostate issue.  Any reccommendations?  We see the neuro in a week with our questions about the keppra.  He is a bit of a pro drug kind of guy but I get the feeling it is a cover your ass world...and he is resigned.  Many questions, any answers? The hyrochlorothiazide??? The Keppra- drop or slow withdraw if we are definately calling it? The bottoming out?  Stable on the meds he is averaging 125/75 would a little less med and a little higher bp 145/80 be better for his circumstances??  Thanks  God Bless!  Mary  

[vega1318]

Glad to know your husband came out so well.  From your description, it is unclear what kind of a stroke he has had -- that is, what was the cause?   What is the reason he is now on Coumadin?  Is it a heart arrhythmia or a blood clot in the heart?  Certain types of strokes are likely to cause seizures and may need to be treated with antiseizure medicines (such as Keppra, which is quite safe) at least temporarily.  Some strokes may cause seizures down the line.  There is no obvious rule regarding whether seizure prophylaxis needs to be given for someone who has not had a seizure, but generally if a stroke had some blood in it or is large enough or, of course, if there was some seizure activity suspected -- it is better to try it.  It is, of course, up to the patient to continue the meds and you should never stop any of these cold, but rather taper off slowly under a doctor's guidance.  Even healthy people may have a seizure if antiseizure meds are stopped cold turkey -- so not a good idea.

Sounds like his BP meds need to be adjusted.  It's not a matter of him taking too many medications, it's just a matter of finding the right combination that will prevent him from having these "bottoming out" episodes.  Your PMD should be able to do this.  In terms of erection, certain medications may interfere as, at times, the fact that he has just had a stroke.  Depression may also play a major role and you should be watchful for that.  Post-stroke depression may or may not be easily treated with "therapy" alone but may rather need to be helped with some minor medication but both you and your husband can determine that.