Medications

Many people are prescribed medications after whiplash injuries, and it is important for you to know what the most common drugs are so that you can recognize any potential adverse effects. The following is a listing of the different categories of drugs used, the common trade names, their indications, and things to look for.  If you have any questions about medications, please contact the physician who prescribed them to you.

Benzodiazepines

Common types: Diazepam (Valium), Aiprazolam (Xanax), Lorazepam (Ativan).

General characteristics: Centrally-acting sedative, hypnotic, and anti-anxiety drugs.

Uses: Anxiety and tension, muscle spasms, sleep disturbances, myofascial pain. Concerns: “All antianxiety agents have the ability to cause psychological and physical dependence. Withdrawal symptoms usually start within 12-48 hr after stopping the drug and last for 12-48 hr...Abrupt withdrawal may be accompanied by coma, convulsions, and even death.”

Adverse Effects: Drowsiness, lightheadedness, fatigue and tiredness, impaired coordina­tion, constipation, skin rashs, dry mouth, dizziness, increased appetite, sexual dysfunc­tion. ^1,2

Muscle Relaxants

Common types: Carisoprodol (Soma), Chlorzoxazone (Paraflex), Cyclobenzaprine (Flexeril), Metaxalone (Skelaxin), Methocarbamol (Delaxin)

General Characteristics: Muscle relaxants work via the central nervous system, decreas­ing muscle tone and involuntary movement throughout the body. They also have some analgesic properties.

Uses: Muscle spasm, tension headaches, inflammation.

Concerns: Should not be used with MAOI or tricyclic anti-depressants, as severe symp­toms can result. Dosage must be tapered when discontinuing treatment to prevent withdrawal symptoms.

Adverse Effects: Dry mouth, drowsiness, weakness, paresthesia, insomnia, dizziness, tachycardia, blurred vision, urinary retention. ^1,2

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

Common types: Acetylsalicylic acid (aspirin), Ibuprofen, Indomethacin (Indocin), Naproxen (Naprosyn).

General Characteristics: Decrease levels of prostoglandins, thereby reducing inflamma­tion. Also have analgesic properties.

Uses: Inflammation, pain, arthritis.

Concerns: Should not be used by pregnant or lactating women. Overuse of this class of drugs can lead to gastrointestinal damage.

Adverse Effects: Ulcer, heartburn, nausea, vomiting, dyspepsia, indigestion, abdominal cramps, dizziness, drowsiness, vertigo, headaches, nervousness, anxiety. ^1,2

Narcotic Analgesics

Common types: Codeine, Fiorinal, Meperidine (Demerol), Percocet, Percodan, Propoxyphene (Darvon).

General Characteristics: These drugs affect the central nervous system, decreasing pain.

Uses: Moderate or severe acute pain. Fiorinal is used for tension headaches. Many whiplash patients are prescribed these drugs for myofascial pain.

Concerns: All of these drugs are potentially addictive. They should not be used for long-term treatment of pain. Also, caution should be used if using alcohol, antianxiety drugs, antidepressants, or muscle relaxants, as these can cause potentially serious additive adverse effects.

Adverse Effects: Respiratory depression, apnea, dizziness, lightheadedness, sedation, lethargy, headache, nausea, vomiting, constipation, skin rashes, urinary retention. ^1,2

Selective Serotonin Reuptake Inhibitors (SSRI's)

Common types: Fluoxetine Hydrochloride (Prozac), Paroxetine Hydrochloride (Paxil), Sertraline Hydrochloride (Zoloft).

General Characteristics: Drug prevents reuptake of serotonin in the body, increasing serotonin levels.

Uses: Indicated for depression, commonly used for depression resulting from chronic pain.

Concerns: These drugs have a large number of side-effects, and are prescribed very often. These drugs can also cause headache and muscle pain, complicating the treatment of whiplash injuries.

Adverse Effects: Headache, insomnia, anxiety, nervousness, dizziness, fatigue, sedation, sexual dysfunction, decreased concentration, agitation, abnormal dreams, paranoid reactions, suicidal ideations, and blurred vision. (This is just a short, general list of symptoms. For each specific drug, there are dozens more documented adverse effects.) ^1,2

Tricyclic Antidepressants

Common Types: Amitriptyline (Elavil), Desipramine (Norpramin), Imipramine (Tofranil), Nortriptyline (Pamelor).

General Characteristics: Prevent the reuptake of norepinephrine or serotonin, or both. They all have a strong sedative effect.

Uses: Depression, chronic pain.,

Concerns: Should not be used with any other antidepressants or alcohol. Should not be used during pregnancy or lactation.

Adverse Effects: Confusion, anxiety, restlessness, insomnia, nightmares, hallucinations, delusions, mania, headache, dizziness, difficulty concentrating, panic reactions, fatigue, blurred vision, nausea, vomiting, fainting, and urinary retention. ^1,2

References:

1.  Loebl S, Spratto GR, Woods AL. The Nurse’s Drug Handbook, 1994.

2.  Melton MR. The Complete Guide to Whiplash, Mind-Body Publications, 1998.

MEDICATIONS Used for Headaches

There are many different medications that have helped people who suffer from headaches following MTBI. Some of these are used to relieve headache pain; others are more useful as preventives. The following table lists some of the types of drugs most commonly used for headaches, plus examples of each type. For each drug listed, the generic name is given first, followed by the brand name or names in parentheses.

Not all drugs help all individuals. It may be necessary for your doctor to try several different prescriptions before finding the one that works best for you. It should be noted that sumatriptan (Imitrex), one of the newer drugs used to treat acute migraine episodes, is generally not recommended for people who have suffered mild traumatic brain injury (MTBI).