Which medication should be avoided in someone with a history of seizures due to lowering the seizure threshold?

• A. Diazepam
• B. Amiodarone
• C. Tramadol
• D. FQ

Answer: (C)

When a patient has a history of seizures, we avoid medications that can increase neuronal excitability or lower the seizure threshold. Tramadol does this more than many other common drugs. It provides analgesia through weak mu-opioid receptor activation and also increases serotonin and norepinephrine in the CNS. This combination can reduce the brain’s seizure threshold, making seizures more likely, especially at higher doses or with other serotonergic or CNS-active medications.

Diazepam, a benzodiazepine, actually raises the seizure threshold and is frequently used to treat seizures, so it’s not a drug to avoid in someone with epilepsy. Amiodarone can have CNS side effects but it’s not classically known for lowering seizure threshold. Fluoroquinolones can lower seizure threshold and provoke seizures in susceptible individuals, but in this context tramadol is the best-known safer-to-avoid choice for someone with a seizure history due to its direct effect on lowering the threshold.