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Medications associated with seizures

Medications associated with seizures
Category Examples
Analgesics
  • Opioids (eg, meperidine, tramadol)
Anticancer drugs*
  • Busulfan
  • Chlorambucil
  • Cytarabine
  • Doxorubicin
  • Etoposide
  • Fluorouracil
  • Interferon alfa
  • Methotrexate
  • Mitoxantrone
  • Nelarabine
  • Platinum-based drugs (eg, cisplatin)
  • Vinblastine
  • Vincristine
Antimicrobials
  • Carbapenems (eg, imipenem)
  • Cephalosporins (fourth generation)
  • Fluoroquinolones (eg, ciprofloxacin)
  • IsoniazidΔ
  • Penicillins
Hypoglycemic agents
  • Potentially any antidiabetic agent that can cause hypoglycemia
Immunosuppressants
  • Azathioprine
  • Cyclosporine
  • Mycophenolate
  • Tacrolimus
Psychiatric medications
  • Antipsychotics◊
  • Atomoxetine
  • Bupropion
  • Buspirone
  • Lithium
  • Monoamine oxidase inhibitors§
  • Selective serotonin reuptake inhibitors¥
  • Serotonin norepinephrine reuptake inhibitors¥
  • Serotonin modulators
  • Tricyclic antidepressants (eg, amoxapine, clomipramine, maprotiline)
Pulmonary drugs
  • Aminophylline
  • Theophylline
Stimulants
  • Amphetamines
  • Methylphenidate
Sympathomimetics and decongestants
  • Anorexiants (eg, diethylpropion, phentermine, nonprescription diet aids)
  • Phenylephrine
  • Pseudoephedrine

The magnitude of risk of seizure for various categories and individual agents is not well established. Factors that may contribute to the risk of seizure with medications include overdose, alcohol abuse, organ dysfunction, drug interactions, older age, and a history of seizures. Illicit drugs use, herbs/natural remedies (eg, guarana), nonprescription supplements, and abrupt withdrawal from chronic alcohol use and certain prescription medicines (eg, antiseizure medications, baclofen, benzodiazepines) are also associated with seizure.

This table is not all-inclusive. For detailed prescribing information, including reported adverse effects, readers should refer to the individual drug information topics within UpToDate. Comprehensive information on drug interactions can be determined using the drug interaction program included within UpToDate.

* For more details and additional anti-cancer drugs that have been associated with seizures, refer to UpToDate topic reviews on the neurologic complications of anticancer therapies.

¶ Among antibiotics, evidence for an association is strongest for unsubstituted penicillins, fourth-generation cephalosporins, imipenem, and ciprofloxacin in combination with renal dysfunction, brain lesions, and epilepsy[1].

Δ Seizures are a manifestation of pyridoxal-5-phosphate deficiency; they respond to pyridoxine and benzodiazepine treatment. Refer to UpToDate topic review on isoniazid poisoning.

◊ Clozapine has a higher risk of seizure than most other antipsychotics[2]; refer to UpToDate topic review on guidelines for prescribing clozapine in schizophrenia for more information.

§ Monoamine oxidase inhibitors include: furazolidone, isocarboxazid, linezolid, moclobemide, pargyline, phenelzine, procarbazine, rasagiline, selegiline, tranylcypromine.

¥ Selective serotonin reuptake inhibitors and serotonin norepinephrine reuptake inhibitors do not increase seizure risk in patients with epilepsy when used in therapeutic doses, but may be proconvulsant at toxic doses[3,4].
References:
  1. Sutter S, Ruegg S, Tschudin-Sutter S. Seizures as adverse events of antibiotic drugs: A systematic review. Neurology 2015; 85:1332.
  2. Hitchings AW. Drugs that lower the seizure threshold. Adverse Drug React Bull 2016; 298:1151.
  3. Kanner AM. Most antidepressant drugs are safe for patients with epilepsy at therapeutic doses: A review of the evidence. Epilepsy Behav 2016; 61:282.
  4. Landmark CJ, Henning O, Johannessen SI. Proconvulsant effects of antidepressants – What is the current evidence? Epilepsy Behav 2016; 61:287.
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