Understanding Medications That May Trigger Seizures

It can be concerning to learn that certain medications, even those prescribed for other conditions, could potentially affect seizure control. If you or a loved one manages a seizure disorder, understanding which drugs might lower the seizure threshold is a critical part of staying safe. This guide provides a clear overview of medication classes linked to increased seizure risk, empowering you to have more informed conversations with your healthcare provider.

Important Medical Disclaimer: This article is for informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Never stop, start, or change the dosage of any medication without consulting your doctor or a qualified healthcare professional.

How Some Medications Can Affect Seizure Risk

The brain maintains a delicate balance of electrical activity. A seizure occurs when there is a sudden, uncontrolled burst of this electrical activity. The “seizure threshold” is the level of stimulation the brain can handle before a seizure is triggered. While this threshold is naturally lower in people with epilepsy, certain substances and medications can lower it even further in susceptible individuals, making a seizure more likely to occur.

It is important to remember that the risk is not the same for everyone. Factors like the specific medication, dosage, individual brain chemistry, and other health conditions all play a role. For many people, these medications can be used safely under careful medical supervision. The key is awareness and open communication with your medical team.

Common Medication Classes to Be Aware Of

Here are some of the most well-known classes of drugs that have been associated with lowering the seizure threshold. This is not an exhaustive list, and the risk varies greatly between specific drugs within a class.

Certain Antidepressants

While many modern antidepressants are considered safe for people with epilepsy, some carry a higher risk.

• Bupropion (Wellbutrin): This medication is one of the most frequently cited antidepressants for lowering the seizure threshold. The risk is dose-dependent, meaning higher doses are associated with a greater risk. It is often avoided in patients with a history of seizures or eating disorders.
• Tricyclic Antidepressants (TCAs): Older antidepressants like amitriptyline and clomipramine can also increase seizure risk, particularly in overdose situations.
• Safer Alternatives: Selective serotonin reuptake inhibitors (SSRIs) like sertraline (Zoloft) or escitalopram (Lexapro) are generally considered to have a much lower risk and are often preferred for patients with epilepsy.

Certain Pain Relievers

Some prescription pain medications can interfere with brain activity and increase seizure risk.

• Tramadol (Ultram): This opioid analgesic is known to lower the seizure threshold, even in people without a prior history of seizures. The risk increases with higher doses and when combined with other medications like antidepressants.
• Meperidine (Demerol): A metabolite of this opioid, called normeperidine, can build up in the body, especially in people with kidney problems, and is known to be a central nervous system irritant that can provoke seizures.

Certain Antibiotics

Infections themselves can sometimes trigger seizures, but certain antibiotics used to treat them can also be a factor.

• Quinolones: This class, which includes drugs like ciprofloxacin (Cipro) and levofloxacin, has been shown to have effects on brain receptors that can lead to seizures, though the risk is generally low for most people.
• Carbapenems: High doses of antibiotics like imipenem, especially in patients with kidney failure or pre-existing brain conditions, have been linked to seizures.
• Penicillin: While generally safe, very high intravenous doses of penicillin can also lower the seizure threshold.

Antipsychotic Medications

These medications are used to treat conditions like schizophrenia and bipolar disorder. Both older (typical) and newer (atypical) antipsychotics can carry a risk.

• Clozapine (Clozaril): This atypical antipsychotic has a well-documented, dose-related risk of causing seizures.
• Chlorpromazine: An older, typical antipsychotic that is also associated with a higher risk compared to other options.

Over-the-Counter (OTC) Drugs and Supplements

It is crucial to be aware that non-prescription products can also pose a risk. Always read labels and talk to your pharmacist.

• Diphenhydramine (Benadryl): This common antihistamine found in allergy pills, cold remedies, and sleep aids can lower the seizure threshold, particularly in high doses or in sensitive individuals.
• Decongestants: Ingredients like pseudoephedrine (Sudafed) are stimulants that can potentially provoke seizures in those who are susceptible.
• Herbal Supplements: Certain supplements like St. John’s Wort, ginkgo biloba, evening primrose oil, and high doses of caffeine can interfere with anti-seizure medications or affect brain activity.

Other Prescription Medications

• Stimulants: Medications for ADHD, such as methylphenidate (Ritalin) and amphetamines (Adderall), can increase seizure risk, although they are often used safely in patients with epilepsy under close monitoring.
• Theophylline: A medication used for asthma and other respiratory diseases can trigger seizures, especially at toxic levels in the blood.

What You Should Do With This Information

Knowledge is power, but it should be used wisely. The goal of this information is not to cause alarm but to encourage proactive health management.

1. Do Not Stop Any Medication: Suddenly stopping a prescribed medication can be dangerous and may even trigger withdrawal seizures. Always speak to your doctor first.
2. Maintain a Complete Medication List: Keep an updated list of everything you take, including prescriptions, over-the-counter drugs, vitamins, and herbal supplements. Share this list with all your healthcare providers.
3. Ask Questions: Whenever you are prescribed a new medication, ask your doctor and pharmacist specifically, “Is this medication safe for someone with a history of seizures?”
4. Communicate Openly: Ensure your neurologist and your primary care physician are aware of all medications prescribed by other specialists. Good communication between your doctors is key to your safety.

Frequently Asked Questions

What should I do if I think a new medication is affecting my seizures? Contact the prescribing doctor and your neurologist immediately. Do not wait for your next appointment. They need to know about any change in seizure frequency or type so they can assess the situation and make any necessary adjustments to your treatment plan.

Are all antidepressants unsafe for people with epilepsy? No, absolutely not. Mental health is incredibly important, and untreated depression can also worsen seizure control. Many antidepressants, particularly SSRIs, are considered safe and effective for people with epilepsy. The decision must be made with your doctor, who can weigh the risks and benefits and choose the best option for you.

Can common cold medicine really trigger a seizure? Yes, it is possible. Certain ingredients in multi-symptom cold and flu remedies, like the decongestant pseudoephedrine or the antihistamine diphenhydramine, can lower the seizure threshold. It is always best to ask your pharmacist to help you choose a product with ingredients that are safer for you.