First Line Drugs
- PROPRANOLOL (C07AA05)
Many medications from different classes have been used in this setting, though conclusive evidence is lacking. Give priority to minimizing the potential side effects when choosing a treatment in these patients. A review of the treatment of agitation and aggression in patients with acquired brain injury found that use of beta-adrenergic antagonists is supported by the best evidence. High doses of propranolol were effective in reducing the incidence of aggression. Antiepileptic drugs such as carbamazepine and divalproex are also used. There is concern about paradoxical disinhibition when benzodiazepines are used in brain-injured patients. Antipsychotics seem to have a generally anti-aggressive effect regardless of the etiology.
There have been small studies of several other medications, including tricyclic antidepressants, selective serotonin reuptake inhibitors, amantadine, buspirone, stimulants and lithium in this patient population, though the evidence is not strong enough to recommend their use as first-line agents.
- Psychiatry and Behaviour