What medications should epileptics avoid? A comprehensive guide

October 11, 2025 •

3 min read

According to a 2007 study of drug-induced seizures reported to a poison control center, bupropion was the leading cause, accounting for 23% of cases. Patients with a history of seizures need to be extremely cautious about what medications they take and understand what medications should epileptics avoid to prevent a seizure recurrence.

Quick Summary

This guide details specific medications and substances that individuals with epilepsy should avoid or use with caution, including certain OTC cold and sleep aids, antibiotics, antidepressants, and pain relievers, to mitigate the risk of seizure triggers.

Key Points

Avoid First-Generation Antihistamines: The active ingredient diphenhydramine in products like Benadryl and Tylenol PM can lower the seizure threshold and must be avoided.
Be Wary of Decongestants: Ingredients like pseudoephedrine and phenylephrine, found in many cold medicines, can act as stimulants and trigger seizures.
Discuss Antidepressants with Your Doctor: While SSRIs are generally safer, some antidepressants like bupropion and older tricyclics carry a higher risk of provoking seizures.
Inform All Doctors About Your Epilepsy: Always disclose your epilepsy diagnosis to any healthcare provider, as certain antibiotics, such as fluoroquinolones and carbapenems, can increase seizure risk.
Steer Clear of Tramadol: This specific synthetic opioid is known to lower the seizure threshold significantly and should be avoided by individuals with epilepsy.
Avoid Herbal Supplements and Illicit Drugs: Herbs like evening primrose oil and illicit drugs like cocaine and amphetamines can act as seizure triggers and should be avoided.
Recognize Withdrawal Risks: Abruptly stopping alcohol or benzodiazepines can lead to seizures and should only be done under medical supervision.

For individuals with epilepsy, managing seizures goes beyond adhering to a prescribed medication regimen; it also requires vigilance about other drugs and substances that can potentially trigger seizures or interfere with anti-epileptic medications (AEDs). These risks can come from over-the-counter (OTC) products, herbal supplements, and even other prescription medications. Being informed is the best defense against accidental seizure triggers.

Over-the-Counter (OTC) Medications to Avoid

Many common OTC products contain ingredients that can lower the seizure threshold or interact negatively with AEDs. Always check the active ingredients before purchasing any non-prescription medicine.

Cold, Flu, and Allergy Medicines

Several compounds found in standard cold, flu, and allergy formulations pose a risk for epileptics. These include first-generation antihistamines like diphenhydramine, decongestants such as pseudoephedrine and phenylephrine, and cough suppressants like dextromethorphan. These can lower the seizure threshold or trigger seizures.

Safer OTC Alternatives

Safer options for cold and allergy symptoms include second-generation antihistamines, which are non-sedating, and nasal saline sprays for congestion. Acetaminophen (Tylenol) and aspirin (for adults) are generally the safest choices for pain and fever.

Prescription Medications Requiring Caution

Certain prescription drugs can interact with AEDs or provoke seizures. Always inform any physician treating you for another condition that you have epilepsy.

Antidepressants

While many newer antidepressants (like SSRIs) are generally safe, some, including bupropion, tricyclic antidepressants, and venlafaxine, carry a higher seizure risk, especially at higher doses.

Antibiotics

Certain antibiotics, including fluoroquinolones, carbapenems (like imipenem), penicillins, and cephalosporins, can lower the seizure threshold. Erythromycin can also interact with some AEDs, increasing their side effects.

Pain Medications

Tramadol is known to lower the seizure threshold and should be avoided. High doses of narcotics and narcotic withdrawal can also trigger seizures.

Other Prescribed Drugs

Atypical antipsychotics (like clozapine) and certain immunosuppressants can also increase seizure risk.

Herbal Supplements and Illicit Drugs

Herbal supplements are unregulated and can interfere with AEDs or brain chemistry. Illicit drugs are particularly dangerous.

Dangerous Supplements

Supplements such as Evening Primrose Oil, Ginkgo, Ginseng, and St. John's Wort have been linked to increased seizure risk or negative interactions with AEDs.

Illicit Drugs and Alcohol

Stimulants (like cocaine) and heavy alcohol use or withdrawal are known to trigger seizures. Benzodiazepine withdrawal can also cause seizures.

Medication Interactions and Contraceptives

Some medications can reduce the effectiveness of AEDs. Certain AEDs can also make hormonal contraceptives less effective, increasing the risk of unplanned pregnancy. Discussion of alternative birth control with a doctor is important.

Comparison Table: Common Medications and Seizure Risk


Drug Class	Examples	Seizure Risk	Recommendation
First-Generation Antihistamines	Diphenhydramine (Benadryl), Tylenol PM	High	Avoid entirely. Use non-sedating alternatives.
Decongestants	Pseudoephedrine, Phenylephrine	Moderate	Avoid. Use nasal saline sprays instead.
Atypical Antidepressants	Bupropion (Wellbutrin), Venlafaxine	Higher for certain types and dosages	Consult a neurologist; often lower risk with newer SSRIs.
Tramadol	Ultram	High	Avoid. Use safer pain management options.
Antibiotics (certain types)	Fluoroquinolones, Imipenem	Increased risk with higher doses or risk factors	Use only if necessary and under close medical supervision.
Herbal Supplements	Evening Primrose Oil, Ginkgo	Variable, often unknown	Avoid or consult doctor. Unpredictable interactions.

Conclusion: The Importance of Communication

Effective epilepsy management requires open communication with healthcare providers about all medications, supplements, and substances being used. Understanding what medications should epileptics avoid is crucial for preventing seizures and ensuring the effectiveness of prescribed AEDs. Never stop AEDs abruptly or start new medications or supplements without consulting your doctor or pharmacist.

For more information and support regarding epilepsy, visit the Epilepsy Foundation.

Frequently Asked Questions

No, you should avoid first-generation antihistamines like diphenhydramine (the active ingredient in Benadryl). These medications can lower the seizure threshold and increase the risk of a seizure.

Nasal saline sprays are a safe alternative for a stuffy nose. For allergies, second-generation, non-sedating antihistamines are generally safe. Always check labels and consult your pharmacist.

Not all are unsafe. While some, like bupropion and tricyclic antidepressants, have a higher seizure risk, newer Selective Serotonin Reuptake Inhibitors (SSRIs) are generally considered safer at standard therapeutic doses.

Individuals with epilepsy should use caution with antibiotics like fluoroquinolones (e.g., ciprofloxacin), carbapenems (e.g., imipenem), penicillins, and cephalosporins. The risk is often dose-dependent and higher for those with existing risk factors.

Acetaminophen (Tylenol) is generally the safest option for treating pain and fever. The synthetic opioid tramadol, in particular, should be avoided.

Yes, some antiepileptic drugs (AEDs) can decrease the effectiveness of hormonal contraceptives. This interaction can also affect the concentration of your seizure medication. Discuss alternative birth control methods with your doctor.

Excessive alcohol consumption and, most importantly, alcohol withdrawal are known seizure triggers. Limiting or avoiding alcohol is often recommended, and withdrawal should be medically supervised.

No, you should never stop or adjust your anti-epileptic medication without a doctor's guidance. Always consult your healthcare provider before making any changes to your medication regimen.