Withdrawal seizures with

In a review of 37 reported cases, Davidson (426) found that the risk of seizures with bupropion was higher at doses above the recommended maximum (i.e., 450 mg per day). An increased risk of seizures was also noted in eating-disordered patients (i.e., bulimics) on bupropion, leading to its temporary withdrawal from the market. With the immediate release formulation, the seizure risk is four per 1,000 patients when the dose is kept at or below 450 mg per day in those without known risk factors (426, 468). The seizure risk may be as low as one per 1,000 patients with the sustained release formulation when the dose is kept below 450 mg per day and the patient has no preexisting seizure history and is not on any medication that also can lower seizure thresholds or interfere with the metabolism of bupropion. 

The most common withdrawal symptoms are emotional in nature. However, the same principle—that withdrawal reactions are the opposite of the primary drug effect—also applies to physical symptoms of withdrawal. A drug that controls blood pressure is likely to result in a reaction with excessively high blood pressure during withdrawal, and a drug that controls seizures can result in seizures during withdrawal. 

Chloroquine can cause seizures in patients with epilepsy. The mechanism is uncertain, but it may include reductions in inhibitory neurotransmitters and pharmacokinetic interactions that alter anticonvulsant concentrations. Tonic-clonic convulsions were reported in four patients in whom chloroquine was part of a prophylactic regimen. Antiepileptic treatment was required to control the seizures. None had further seizures after withdrawal of the antimalarial drugs (9). 

Another patient with a history of bipolar mood disorder experienced had his first four episodes of seizures with a prolonged delirious state 1 week after withdrawal of interferon alfa (73). 

In addition to the symptoms described above, abrupt withdrawal from sedative-hypnotic dependence may include hyperreflexia progressing to seizures, with ensuing coma and possibly death. The risk of a convulsion is increased if the patient abruptly withdraws from ethanol use at the same time. The answer is (D),... 

Visual hallucinations have been seen in one patient given zolpi-dem with bupropion. Bupropion is contraindicated during the abrupt withdrawal from any drug known to be associated with seizures on withdrawal, particularly benzodiazepines and related drugs. 

Visual hallucinations lasting 3 to 4 hours occurred in a 17-year-oid boy who had been taking bupropion 450 mg daiiy for one month and zolpidem 5 to 10 mg daily for about 6 months, when he increased the zolpidem dose to 60 mg. Note that the recommended dose of zolpidem is 10 mg daily and that zolpidem itself can cause psychiatric adverse effects such as hallucinations. Therefore an interaction is not established. Bupropion is contraindicated during abrupt withdrawal from any drug known to be associated with seizures on withdrawal, particularly benzodiazepines and benzodiazepine-like drugs. ... 

Information appears to be limited to these reports, three of which are by the same author. The incidence is not known but if venlafaxine and any tricyclic antidepressant are given concurrently, be alert for any evidence of increased antimusearinie adverse effects. Although there appears to be only one report, the possibility of an increased risk of seizures with concurrent use should be borne in mind. It may be necessary to withdraw one or other of the two drugs. The reports of the serotonin syndrome highlight the need for caution when one or more serotonergic drugs are given either concurrently or within a short period of each other. 

In overdose, ketamine may lead to hyperthermia, seizures, hypertensive crisis, coma, and even death. These symptoms are generally thought to be caused by ketamine s catecholaminergic effects (Reich and Silvay 1989). Ketamine is physically addicting, with a described withdrawal syndrome. 

Severe withdrawal symptoms, including insomnia, irritability, agitation, withdrawal seizures, and delirium, have been described in both mice and humans chronically exposed to the anesthetics nitrous oxide, ether, and isoflurane (Arnold et al. 1993 Delteil et al. 1974 Deniker et al. 1972 Harper et al. 1980 Smith et al. 1979 Tobias 2000). These symptoms were controlled with the administration of y-aminobutyric acid (GABA)-ergic agents such as pentobarbital, midazolam, and diazepam (Arnold et al. 1993 Hughes et al. 1993). 

Administered only when the CIWA-Ar score is >9. May administer with a lower threshold (i.e., CIWA-Ar score <9) if there is a history of withdrawal seizures... 

Individuals who fulfill all of these criteria have a 61% chance of remaining seizure-free after AEDs are discontinued. Additionally, there is a direct relationship between the duration of seizure freedom while taking medications and the chance of being seizure-free after medications are withdrawn. Withdrawal of AEDs is done slowly, usually with a tapering dose over at least 3 months. 

Oxazepam is available in oral form only, so it is useful only for uncomplicated withdrawal. Other benzodiazepines are available in injectable form and will be further described below. Diazepam and lorazepam are more lipophilic than chlordiazepoxide and oxazepam, resulting in quicker gastrointestinal absorption and passage across the blood-brain barrier, which makes them valuable in an inpatient setting, especially to treat or prevent seizures. However, their faster onset of action maybe associated with feeling high, which can be a disadvantage of their use. 

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