From the Research
Aripiprazole is the antipsychotic least likely to cause seizures, based on its unique mechanism as a partial dopamine agonist and the available evidence from recent studies. The risk of seizures with antipsychotics is related to their effects on lowering the seizure threshold in the brain, with medications that have stronger dopamine-blocking properties or that affect multiple neurotransmitter systems typically carrying higher risk 1.
Factors Influencing Seizure Risk
When prescribing antipsychotics to patients with epilepsy or seizure risk factors, several factors should be considered to minimize the risk of seizures:
- Starting with lower doses and titrating slowly is recommended 1
- High doses, rapid dose escalation, history of seizures, brain injury, or concurrent use of other medications that lower seizure threshold can increase seizure risk 2, 1
- The type of antipsychotic used, with some having a higher risk of seizure induction than others, such as clozapine, which is known to have a high risk of seizures 3, 4, 1
Antipsychotics with Low Seizure Risk
Other antipsychotics with low seizure risk include:
- Paliperidone (Invega)
- Lurasidone (Latuda)
- Brexpiprazole (Rexulti) These medications, along with aripiprazole, are considered to have a lower risk of seizure induction compared to other antipsychotics, making them preferable options for patients with a history of seizures or at risk of seizures 2, 1.
Clinical Considerations
In clinical practice, the choice of antipsychotic should be guided by the individual patient's risk factors for seizures, as well as the specific characteristics of the antipsychotic medication, including its potential to lower the seizure threshold 3, 5. By carefully considering these factors and selecting an antipsychotic with a low risk of seizure induction, clinicians can minimize the risk of seizures in their patients.