Early pharmacological support for post- stroke neurorehabili-tation has seen an abundance of mixed results from clinical trials, leaving practitionersat a loss regarding the best options to improve patient outcomes. The objective of thisevidence-based guideline is to support clinical decision-making of healthcare profession-als involved in the recovery of stroke survivors.

Methods:

This guideline was developed using the Grading of Recommendations,Assessment, Development and Evaluation (GRADE) framework. PubMed, CochraneLibrary and Embase were searched (from database inception to June 2018, inclusive) toidentify studies on pharmacological interventions for stroke rehabilitation initiated in thefirst 7 days (inclusive) after stroke, which were delivered together with neurorehabilita-tion. A sensitivity analysis was conducted on identified interventions to address resultsfrom breaking studies (from end of search to February 2020).

esults:

Upon manually screening 17,969 unique database entries (of 57,001 originalquery results), interventions underwent meta- analysis. Cerebrolysin (30 ml/day, intrave-nous, minimum 10 days) and citalopram (20 mg/day, oral) are recommended for clinical usefor early neurorehabilitation after acute ischaemic stroke.

The remaining interventionsidentified by our systematic search are not recommended for clinical use:

amphetamine(5, 10 mg/day, oral), citalopram (10 mg/day, oral), dextroamphetamine (10 mg/day, oral),Di-Huang-Yi-Zhi (2 × 18 g/day, oral), fluoxetine (20 mg/day, oral), lithium (2 × 300 mg/day,oral), MLC601(3 × 400 mg/day, oral), phosphodiesterase-5 inhibitor PF-03049423 (6 mg/day, oral). No recommendation ‘for’ or ‘against’ is provided for selegiline (5 mg/day, oral).Issues with safety and tolerability were identified for amphetamine, dextroamphetamine,fluoxetine and lithium.

Conclusions:

This guideline provides information for clinicians regarding existing phar-macological support in interventions for neurorecovery after acute ischaemic stroke.Updates to this material will potentially elucidate existing conundrums, improve currentrecommendations, and hopefully expand therapeutic options for stroke survivors.