title: Controlled-release oxycodone-induced seizures.
abstract: BACKGROUND
  The use of the opioid oxycodone hydrochloride in the management of chronic pain is gaining popularity principally because of its tolerability. However, opioid-related seizure in patients with epilepsy or other conditions that may decrease seizure threshold has been described in the literature; in particular, oxycodone has been associated with seizure in a patient with acute renal failure.
  
  
  OBJECTIVE
  The aim of this article was to report a patient with a history of seizures but normal renal and hepatic function who developed seizure on 2 occasions after oxycodone ingestion.
  
  
  METHODS
  A 54-year-old male patient presented with a history of tonic-clonic seizures that developed immediately after intracranial surgery. Long-term treatment with carbamazepine 400 mg QD was started, and the patient was free of convulsions for approximately 7 years. The patient presented to us with severe headache that was nonresponsive to an NSAID and the opiate agonist tramadol. Treatment with controlled-release (CR) oxycodone and tramadol drops (50 mg QID if necessary) was started, and tonic-clonic seizures developed 3 days later.
  
  
  RESULTS
  Based on laboratory analysis, the patient had normal renal and hepatic function. On discontinuation of oxycodone treatment, the seizures resolved. However, due to effective pain relief with oxycodone, the patient decided to continue treatment, and seizures recurred. Carbamazepine was then administered 4 hours before oxycodone dosing, which allowed continuation of treatment without seizure.
  
  
  CONCLUSIONS
  A patient with a history of seizures controlled with long-term carbamazepine therapy developed seizures when he started treatment with oxycodone CR at recommended doses. Oxycodone CR should be used with extreme caution in patients with epilepsy or other conditions that may decrease seizure threshold.
authors.affiliation: Division of Anesthesiology and Critical Care Medicine, Soroka Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva 84101, Israel. motiklein@yahoo.com
authors.forename: Moti
authors.initials: M
authors.lastname: Klein
authors.forename: Zvia
authors.initials: Z
authors.lastname: Rudich
authors.forename: Boris
authors.initials: B
authors.lastname: Gurevich
authors.forename: Matityahu
authors.initials: M
authors.lastname: Lifshitz
authors.forename: Silviu
authors.initials: S
authors.lastname: Brill
authors.forename: Michael
authors.initials: M
authors.lastname: Lottan
authors.forename: Natan
authors.initials: N
authors.lastname: Weksler
mesh_terms: D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects*; D003692:Delayed-Action Preparations; D006261:Headache / Q000188:drug therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010098:Oxycodone / Q000008:administration & dosage / Q000009:adverse effects*; D012640:Seizures / Q000139:chemically induced*
chemical_list: D000701:Analgesics, Opioid; D003692:Delayed-Action Preparations; D010098:Oxycodone