Antipsychotic Seizure Risk Assessment
Evidence-based seizure risk evaluation and drug interaction analysis
🧠 Patient Assessment
📚 Comprehensive Antipsychotic Seizure Risk Comparison
| Medication | Risk Level | Seizure Rate | Dose Dependent | Threshold | Key Considerations |
|---|---|---|---|---|---|
| Clozapine (Clozaril) | Very High | 3-5% | Yes | 600mg/day | Highest seizure risk among antipsychotics. Risk increases dramatically >600mg/day (up to 20% at >900... |
| Chlorpromazine (Thorazine) | High | 0.5-1.2% | Yes | 1000mg/day | Highest risk among typical antipsychotics. Risk increases with high doses and IV administration.... |
| Olanzapine (Zyprexa) | Moderate-High | 0.9% | Yes | 20mg/day | Highest seizure risk among second-generation antipsychotics except clozapine. Exercise caution with ... |
| Quetiapine (Seroquel) | Moderate | 0.5-0.8% | Yes | 800mg/day | Moderate seizure risk, primarily at high doses. Generally well-tolerated in patients with seizure hi... |
| Risperidone (Risperdal) | Low-Moderate | 0.3% | No | N/A | Low seizure risk across dose range. Relatively safe in patients with seizure disorders.... |
| Haloperidol (Haldol) | Low-Moderate | 0.1-0.5% | Yes | 100mg/day | Lower seizure risk than low-potency typical antipsychotics. Risk increases with very high doses.... |
| Asenapine (Saphris) | Low-Moderate | 0.2% | No | N/A | Low seizure risk in clinical trials. Limited post-marketing data available.... |
| Aripiprazole (Abilify) | Low | <0.1% | No | N/A | Lowest seizure risk among antipsychotics. May have seizure-protective effects due to partial dopamin... |
| Ziprasidone (Geodon) | Low | <0.1% | No | N/A | Very low seizure risk. Safe option for patients with seizure disorders.... |
| Paliperidone (Invega) | Low | <0.1% | No | N/A | Low seizure risk profile similar to risperidone. Well-tolerated in seizure-prone patients.... |
| Lurasidone (Latuda) | Low | <0.1% | No | N/A | Very low seizure risk. Excellent safety profile for seizure-prone patients.... |
| Cariprazine (Vraylar) | Low | <0.1% | No | N/A | Very low seizure risk. Similar safety profile to aripiprazole.... |
💡 Click any row to select that medication for assessment
⚗️ Anti-Epileptic Drug Interaction Summary
Carbamazepine
Strong CYP3A4 inducer
Key Interactions:
Major:
Aripiprazole (Abilify), Quetiapine (Seroquel), Lurasidone (Latuda)
Moderate:
Haloperidol (Haldol), Ziprasidone (Geodon), Risperidone (Risperdal), Olanzapine (Zyprexa), Clozapine (Clozaril)
Phenytoin
Strong CYP3A4 inducer
Key Interactions:
Major:
Aripiprazole (Abilify), Quetiapine (Seroquel)
Moderate:
Ziprasidone (Geodon), Haloperidol (Haldol), Clozapine (Clozaril)
Valproate
CYP enzyme inhibitor
Key Interactions:
Moderate:
Clozapine (Clozaril)
Lamotrigine
Minimal CYP effects
Key Interactions:
Levetiracetam
No CYP interactions
Key Interactions:
💎 Clinical Pearls
🏆 Safest Options
- Aripiprazole: Lowest risk, may be seizure-protective
- Ziprasidone: Very low risk, good for seizure history
- Lurasidone: Excellent safety profile
- Paliperidone: Similar to risperidone, low risk
⚠️ Highest Risk Agents
- Clozapine: 3-5% risk, up to 20% at high doses
- Chlorpromazine: Highest risk among typicals
- Olanzapine: Highest risk among SGAs (except clozapine)
🔄 AED Interactions
- Carbamazepine/Phenytoin: Major CYP3A4 inducers
- Levetiracetam: No significant interactions
- Lamotrigine: Minimal CYP effects
- Monitor levels when combining inducers
📋 Monitoring Tips
- Start low, go slow with high-risk agents
- Baseline EEG for seizure history patients
- Weekly assessments during initial month
- Patient education on seizure warning signs
🚨 Emergency Management
If Seizure Occurs:
Immediate Actions:
- Ensure patient safety (protect airway)
- Time the seizure duration
- Do not restrain or force objects in mouth
- Turn patient to side if possible
- Call 911 if seizure >5 minutes
Post-Seizure Management:
- Discontinue or reduce antipsychotic dose
- Obtain serum drug levels if applicable
- Neurological consultation
- Consider EEG and brain imaging
- Evaluate for precipitating factors