Pharmacist-led management of suspected drug-provoked seizures and sequential antiseizure medication adverse reactions: a case report
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…
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