ArticleFrontiers in pharmacology2026
Pharmacist-led management of suspected drug-provoked seizures and sequential antiseizure medication adverse reactions: a case report.
Article in Frontiers in pharmacology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Drug-provoked seizures constitute a clinically significant yet frequently underappreciated complication of pharmacotherapy, particularly among patients receiving antimicrobial agents with established seizurogenic potential. The subsequent management of sequential adverse drug reactions (ADRs) arising from antiseizure medication (ASM) use introduces additional pharmacological and clinical complexity. Case Summary: A 73-year-old man with a remote history of epilepsy, moderate chronic kidney disease (CKD), and decade-long anticonvulsant self-discontinuation experienced two generalised tonic-clonic seizures during sleep on completion of a five-day course of intravenous moxifloxacin 0.4 g once daily and intravenous diprophylline 0.5 g twice daily for an acute COPD exacerbation. The clinical pharmacist identified the events as consistent with suspected drug-provoked seizures, hypothesising that renal impairment-driven diprophylline accumulation may have acted as a pharmacokinetically amplified pro-convulsant mechanism; as serum diprophylline concentrations were not measured, this mechanism is proposed as hypothesis-generating rather than established. Three sequential ASM-associated ADRs were subsequently detected and managed through proactive pharmacist-led pharmacovigilance: suspected sodium valproate-induced rhabdomyolysis (Naranjo score 8; confounded by post-ictal rhabdomyolysis and concurrent statin use), symptomatic oxcarbazepine-induced hyponatraemia requiring drug substitution, and suspected levetiracetam-associated hepatotoxicity not fulfilling formal drug-induced liver injury (DILI) criteria. Conclusion: This case underscores the indispensable role of clinical pharmacist engagement in identifying suspected drug-provoked seizures, applying structured causality assessment in the presence of competing confounders, and systematically managing complex, sequential ASM-related adverse reactions in high-risk patients.
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