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Related Experiment Videos

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
PubMed
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.

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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.

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  • 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.