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DRUG INFORMATION ROUNDS

Seizure Potential of Concomitant Medications and Radiographic Contrast Media Agents

Drug Information Specialty Resident, School of Pharmacy, University of Pittsburgh; Adjunct Instructor, Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA

Nicole T Ansani, PharmD

Associate Director, Drug Information Center, School of Pharmacy, University of Pittsburgh; Assistant Professor, Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh

Reprints: Bethany A Fedutes PharmD, Department of Pharmacy and Therapeutics, University of Pittsburgh Medical Center, 302 Scaife Hall, 200 Lothrop St., Pittsburgh, PA 15213-2546, FAX 412/624-6350, fedutesba{at}msx.upmc.edu

OBJECTIVE: To review seizure risk of concomitant medication administration and nonionic, water-soluble radiographic contrast media agents for myelography.

DATA SOURCES: Clinical literature was identified through MEDLINE (1966–May 2003). Key search terms included metrizamide, iohexol, myelogram, myelography, seizure, and contraindications.

DATA SYNTHESIS: Administration of myelography contrast media can produce rare serious adverse events, including meningeal irritation, seizures, or psychological disturbances. An evaluation of case reports and clinical trials concerning seizure risks of nonionic, water-soluble radiographic myelography contrast media and concomitant medications with potential to lower the seizure threshold was performed.

CONCLUSIONS: Available data supporting the incidence of increased seizure risk with nonionic, water-soluble contrast media agents and concomitant medication administration that lowers the seizure threshold are anecdotal. However, because of product labeling and additive potential to decrease the seizure threshold, discontinuation of such medications should be considered to avoid the presumed increased risk of seizures.

Key Words: contraindications, contrast media, iohexol, metrizamide, myelogram, myelography, seizure

Published Online, August 8, 2003. www.theannals.com, DOI 10.1345/aph.1C464

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