Epileptogenic Potential of Carbapenem Agents

Mechanism of Action, Seizure Rates, and Clinical Considerations

April D. Miller, Pharm.D.; Amanda M. Ball, Pharm.D.; P. Brandon Bookstaver, Pharm.D.; Emily K. Dornblaser, Pharm.D.; Charles L. Bennett, M.D., Ph.D.


Pharmacotherapy. 2011;31(4):408-423. 

In This Article


Seizures associated with carbapenem agents are a relatively rare but clinically significant phenomenon. The first widely used agent in this class, imipenem-cilastatin, is more frequently associated with seizures than other carbapenems, whereas the rate of seizure occurrences with meropenem appears to be low. The newer carbapenems, doripenem and ertapenem, also appear to have a low seizure rate, but more widespread use of these agents in a variety of clinical settings will further elucidate the association between these agents and seizures.

Management of seizures in this setting is optimized by using therapies with GABA activity. In treating severe infections in patients with underlying neurologic comorbidities, the seizure propensity of carbapenem agents should be taken into account, and dosages should be adjusted for renal dysfunction. Clinicians are advised to be vigilant about the possibility of carbapenem-induced seizures. Because of the relatively rare occurrence of seizures in formalized clinical trials, postmarketing reports are essential for the drug safety process. Adverse drug reaction reporting systems and case reports will provide important data to further understand the spectrum of carbapenem-induced seizures.


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