Certain medications can lower the seizure threshold and should be used cautiously or avoided in patients with a history of seizures.
Risk of seizure can be further increased if:
- The medication is taken in combination with a medication that inhibits their metabolism, resulting in higher concentrations of the medication in the body
- The patient has underlying liver or renal disease and is unable to eliminate the medication properly
- The medication is taken with alcohol
- The medication is taken with multiple medications that have the potential to lower the seizure threshold
- Other factors that can contribute to lowering the seizure threshold besides medications include: older age, illicit drug use, herbs and supplements, and abrupt withdrawal from certain medications or chronic alcohol use
| Medication Category | Specific Examples |
|---|---|
| Analgesics | Tramadol (Ultram), Tapentadol (Nucynta) Meperidine (Demerol) Fentanyl (Duragsic) |
| Antibiotics | Imipenem Penicillins Cefepime Fluoroquinolones (eg Ciprofloxacin) Isoniazid Linezolid |
| Antidepressants | Bupropion (Wellbutrin) Tricyclics (Imipramine) SSRIs/SNRIs (do not increase risk when used at therapeutic doses, but may increase risk at toxic doses) |
| Antipsychotics | Clozapine (higher risk than most other antipsychotics) Haldol Olanzapine |
| Decongestants | Phenylephrine Pseudoephedrine (Sudafed) |
| Hypoglycemics | Any diabetic agent that can cause hypoglycemia |
| MAOI’s | Rasagiline, Selegiline |
| Pulmonary | Theophylline |
| Stimulants | Amphetamines Methylphenidate (Ritalin) |
References:
- Sutter S, Ruegg S, Tschudin-Sutter S. Seizures as adverse events of antibiotic drugs: A systematic review. Neurology 2015; 85:1332.
- Hitchings AW. Drugs that lower the seizure threshold. Adverse Drug React Bull 2016; 298:1151.
- Kanner AM. Most antidepressant drugs are safe for patients with epilepsy at therapeutic doses: A review of the evidence. Epilepsy Behav2016; 61:282.
- Landmark CJ, Henning O, Johannessen SI. Proconvulsant effects of antidepressants – What is the current evidence? Epilepsy Behav 2016;61:287