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Br J Clin Pharmacol. 2016 Mar;81(3):412-9. doi: 10.1111/bcp.12720. Epub 2015 Sep 17.

Treatment of drug-induced seizures.

Author information

1
California Poison Control System, Department of Clinical Pharmacy, University of California, San Francisco, USA.
2
Department of Emergency Medicine, Chang-Gung Memorial Hospital, Taoyuan, Taiwan.
3
Division of Clinical Pharmacology & Toxicology, San Francisco General Hospital, San Francisco, USA.
4
Department of Internal Medicine, University of California Davis School of Medicine and Veterans Administration Northern California Health Care System, California.

Abstract

Seizures are a common complication of drug intoxication, and up to 9% of status epilepticus cases are caused by a drug or poison. While the specific drugs associated with drug-induced seizures may vary by geography and change over time, common reported causes include antidepressants, stimulants and antihistamines. Seizures occur generally as a result of inadequate inhibitory influences (e.g., gamma aminobutyric acid, GABA) or excessive excitatory stimulation (e.g. glutamate) although many other neurotransmitters play a role. Most drug-induced seizures are self-limited. However, status epilepticus occurs in up to 10% of cases. Prolonged or recurrent seizures can lead to serious complications and require vigorous supportive care and anticonvulsant drugs. Benzodiazepines are generally accepted as the first line anticonvulsant therapy for drug-induced seizures. If benzodiazepines fail to halt seizures promptly, second line drugs include barbiturates and propofol. If isoniazid poisoning is a possibility, pyridoxine is given. Continuous infusion of one or more anticonvulsants may be required in refractory status epilepticus. There is no role for phenytoin in the treatment of drug-induced seizures. The potential role of ketamine and levetiracetam is promising but not established.

KEYWORDS:

anticonvulsants; poisoning; seizures

PMID:
26174744
PMCID:
PMC4767205
[Available on 2017-03-01]
DOI:
10.1111/bcp.12720
[Indexed for MEDLINE]
Free PMC Article

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