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Controlled-release oxycodone-induced seizures
Moti Klein1, Zvia Rudich, Boris Gurevich
1Division of Anesthesiology and Critical Care Medicine, Soroka Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva 84101, Israel. motiklein@yahoo.com
Clinical Therapeutics
|December 22, 2005
Summary
Oxycodone hydrochloride, used for chronic pain, can trigger seizures in epilepsy patients. This case highlights the need for caution with oxycodone CR in patients with a history of seizures, even when on carbamazepine therapy.
Area of Science:
- Neurology
- Pharmacology
Background:
- Oxycodone hydrochloride is increasingly used for chronic pain due to its tolerability.
- However, opioid-induced seizures are a known risk, particularly in patients with epilepsy or conditions lowering seizure threshold.
- Previous reports have linked oxycodone to seizures in patients with acute renal failure.
Observation:
- A 54-year-old male with a history of epilepsy, controlled for 7 years with carbamazepine, presented with severe headache.
- Initial pain management with NSAIDs and tramadol was ineffective.
- Treatment was initiated with controlled-release (CR) oxycodone and tramadol.
Findings:
- The patient experienced tonic-clonic seizures three days after starting oxycodone CR.
- Seizures resolved upon oxycodone discontinuation and recurred upon reinitiation.
- Concurrent administration of carbamazepine four hours prior to oxycodone dosing prevented seizures, allowing continued oxycodone treatment.
Implications:
- This case underscores that oxycodone CR can precipitate seizures in patients with epilepsy, even when seizures are otherwise controlled.
- Physicians should exercise extreme caution when prescribing oxycodone CR to patients with a history of seizures or conditions predisposing to seizures.
- Co-administration of anticonvulsants like carbamazepine may mitigate seizure risk in susceptible individuals.