Top 10 Meds That Induce Seizures

When working with patients who have a seizure disorder, it’s critical for pharmacists to remember which medications can lower the seizure threshold. Even in patients without epilepsy, some drugs can increase seizure risk, especially at high doses, in overdose situations, or in combination with other risk factors such as electrolyte disturbances, drug interactions, or abrupt withdrawal. Here are 10 common meds that induce seizures that pharmacists should always keep in mind.

Antidepressants are a frequent concern. Bupropion is one of the most well-known offenders and carries a dose-dependent risk of seizures, particularly in patients with eating disorders or a history of head trauma. This is the most likely medication you’ll see on your pharmacology and board exams. Tricyclic antidepressants (like amitriptyline) can also lower the seizure threshold, especially in overdose scenarios. SSRIs and SNRIs are unlikely to cause this issue at therapeutic dosages, but still have been implicated in some cases in overdose-type situations.

Stimulants are frequently used in the management of ADHD. Medications like methylphenidate and amphetamine derivatives have been associated with lowering seizure threshold. Similar to some antidepressants, the risk is associated with higher dosages.

Antipsychotics are another big category. Clozapine is notorious for causing seizures, particularly at higher doses, and requires careful monitoring. Other antipsychotics like chlorpromazine and olanzapine can also contribute to risk. Combining these medications with other seizure-threshold–lowering drugs can further compound the problem.

Antibiotics like fluoroquinolones and imipenem have been associated with inducing seizures and should be ruled out as a potential contributing factor.

Analgesics and other miscellaneous agents are often overlooked. Tramadol has serotonergic activity and is well known to trigger seizures, especially at higher dosages. Meperidine is another opioid with seizure risk due to the accumulation of its metabolite normeperidine.

It is important to think about medications that can induce hypoglycemia. Insulin and sulfonylurea can cause low blood sugar, and if levels reach a certain threshold, seizures are possible.

Finally, withdrawal from certain medications can precipitate seizures. The two biggest culprits here are benzodiazepines and alcohol. Patients with long-term use of either are at significant risk if they abruptly stop. As pharmacists, recognizing when patients are on these therapies and ensuring proper tapering is critical to preventing serious withdrawal-related seizures.

In summary, the top 10 medications and situations to remember are:

Bupropion
Stimulants
Clozapine
Imipenem
Tramadol
Meperidine
Fluoroquinolones
Hypoglycemia-inducing agents
Benzodiazepine withdrawal
Alcohol withdrawal

Being mindful of these medications can help pharmacists identify at-risk patients and prevent avoidable seizure events. What other medications would you add to this list?

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