From the Guidelines
Antipsychotics with the lowest seizure risk include aripiprazole, which is considered a safer option for patients with seizure disorders or those at high risk for seizures, as noted in the most recent study 1. The use of antipsychotics can lower the seizure threshold, and the risk is dose-dependent, so using the lowest effective dose is crucial for minimizing this risk. Some key points to consider when prescribing antipsychotics to patients with epilepsy or seizure risk factors include:
- Starting with low doses and titrating slowly while monitoring for seizure activity
- Avoiding rapid dose escalation, intravenous administration, and drug interactions
- Being aware of the potential for antipsychotic-induced seizures, particularly with clozapine, which has a higher risk of seizures compared to other antipsychotics 1
- Considering the use of aripiprazole, which has been noted to have a lower risk of seizures compared to other antipsychotics, such as clozapine 1 It's also important to note that the mechanism behind antipsychotic-induced seizures involves their effects on various neurotransmitter systems, particularly dopamine, serotonin, and GABA, which can lower the seizure threshold 1. Overall, when prescribing antipsychotics, it's essential to weigh the benefits and risks and to carefully monitor patients for seizure activity, especially those with a history of seizure disorders or risk factors.
From the FDA Drug Label
5.13 Seizures During clinical trials, seizures occurred in 0.5% (20/3490) of patients treated with quetiapine compared to 0.2% (2/954) on placebo and 0. 7% (4/527) on active control drugs. The FDA drug label does not answer the question.
From the Research
Antipsychotics and Seizure Risk
The risk of seizure associated with antipsychotic medications is a significant concern. Studies have investigated the seizure-inducing potential of various antipsychotics, including both first-generation and second-generation antipsychotics.
First-Generation Antipsychotics
- Molindone, haloperidol, fluphenazine, pimozide, and trifluoperazine are associated with a lower risk of seizure induction 2
- Chlorpromazine appears to be associated with the greatest risk of seizure provocation among first-generation antipsychotics 2, 3
Second-Generation Antipsychotics
- Clozapine is the second-generation antipsychotic most frequently associated with seizures 2, 3, 4
- Risperidone, quetiapine, amisulpride, and aripiprazole seem to pose a significantly lower risk of seizure induction 2, 3, 5
- Olanzapine may pose a higher risk of seizures than some other second-generation antipsychotics 5, 6
Factors Influencing Seizure Risk
- History of seizure activity, concurrent use of other drugs that lower seizure threshold, rapid dose titration, slow drug metabolism, metabolic factors, and drug-drug interactions appear to increase the chances of an antipsychotic medication inducing seizure activity 2, 3
- Starting with a small dose of antipsychotic drug, titrating slowly, monitoring serum levels of prescribed drugs, and keeping the drug at the minimal effective dose can help diminish the risk of seizures 3