What medications are safe to take with seizure medications if you have a respiratory bug?

We’re in the midst of cold and flu season, and a very common question is what medications are safe to take with seizure medications if you have a respiratory bug.

In general, fever and lack of sleep will be the biggest problems for people who are ill and have epilepsy. These can make it easier for your brain to have a seizure. However, pseudoephedrine and dextromethorphan can also lower the seizure threshold and are common ingredients in many cold medications. Guaifenesin does not seem to be as much of a problem. Some people are also sensitive to antihistamines, so we suggest that you avoid diphenhydramine (Benadryl) and cetirizine (Zyrtec). Of course, there are individual differences in sensitivities. If you had a reaction to cold medication or think you had a seizure because of a cold medication in the past, don’t try it again. Keep taking your seizure medications regularly.

The best way to deal with a cold or the flu is to avoid getting it. Those of us who work in healthcare get our flu shots beginning in September & October. This helps us to prime our immune system so that we can avoid getting sick. It’s not perfect, but definitely helps to cut back on how many people get sick and especially how many people wind up in the hospital. Many people fear that they will get the flu by receiving the vaccination, but the achiness, fatigue, and sometimes mild fever that some people experience is actually your immune system revving up its engines. You cannot get the flu from the flu vaccine. But, if your reactions have been severe, or you have an autoimmune disorder, you should contact your primary care provider for advice.

Last year, influenza killed almost 80,000 Americans, many of whom were elderly or children. It is a real issue and should not be taken lightly. The CDC estimates that about 6-7 million people have already had flu this season (October- March is the usual flu and cold season) and up to 83,000 may have been hospitalized. That’s a lot of people and it’s still early January!  Most respiratory infections are viral and not bacterial. Therefore, they do not require treatment with an antibacterial agent (antibiotics). But if you are suffering from a bacterial illness, which would be unusual, it is important to remind your doctor and pharmacist that some antibiotics may also lower the seizure threshold, making it more likely that you could have a seizure. The choice of antibiotic is dependent on the type of bacteria you are likely to have, but if there are options, avoiding the fluoroquinolone and carbapenem classes of antibiotics is preferable.

People with chronic illnesses like heart disease, diabetes, chronic neurological diseases and other significant medical problems, including uncontrolled seizures, may consider getting the pneumococcal pneumonia vaccine. This prevents one of the deadliest forms of bacterial pneumonia. The shingles vaccine is also recommended for people over 50. These vaccines are best discussed with your primary care provider, but the flu and pneumonia vaccines are often given prior to discharge in hospitalized patients. Epilepsy is not a contraindication to receiving these vaccinations.

Other remedies such as mom’s chicken soup, honey and lemon to soothe a cough, and pushing fluids are comforting and helpful to many. Make sure you’re getting enough sleep and most importantly, be sure you wash your hands regularly.  Use soap and water whenever possible, and hand sanitizer in between. Scrub thoroughly for about 20 seconds or as long as it takes to sing “Happy Birthday” to yourself twice.  Do not touch contaminated surfaces. Many medical professionals were trained to turn off faucets and grab door knobs with paper towels so that we don’t come into contact with potentially infectious surfaces. Cold viruses can last up to 7 days on surfaces, and flu up to 24 hours.

If you have to cough or sneeze, cover it! Use your elbow, not your hand. Wash your hands after you wipe your nose. Avoid touching your eyes, nose, and mouth after touching potentially contaminated surfaces. But, if you do get sick, be a good friend and co-worker by avoiding getting others sick. Stay home until your fever has been gone for 24 hours.

We wish you a healthy and prosperous New year!


By Jean Cibula, MD, FAES