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Acute ischaemic stroke is a common condition. Drug treatment involves a small window of opportunity for thrombolysis with intravenous alteplase. Other acute supportive drug interventions include insulin, antipyretics and antihypertensives for maintaining normoglycaemia, euthermia and to treat severe hypertension. Anticoagulants and antiplatelet agents have a role in the prevention of recurrent strokes, and osmotic diuretics and antiepileptics may be used to treat complications of stroke.