Did You Know? Medications and Seizure Threshold

Aug 2, 2022 | Did You Know?

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 CategorySpecific Examples
AnalgesicsTramadol (Ultram), Tapentadol (Nucynta)
Meperidine (Demerol)
Fentanyl (Duragsic)
Fluoroquinolones (eg Ciprofloxacin)
AntidepressantsBupropion (Wellbutrin)
Tricyclics (Imipramine)
SSRIs/SNRIs (do not increase risk when used at therapeutic doses, but may
increase risk at toxic doses)
AntipsychoticsClozapine (higher risk than most other antipsychotics)
Pseudoephedrine (Sudafed)
HypoglycemicsAny diabetic agent that can cause hypoglycemia
MAOI’sRasagiline, Selegiline
Methylphenidate (Ritalin)
**This is not an all-inclusive list, but includes those medications commonly seen in LTC.


  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 Behav2016; 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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Brandi VanValkenburg

Brandi provides personalized care as a pharmacy consultant with HealthDirect's northeastern region.  She has been serving our clients for over 10 years. 

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