Evening Primrose Oil and Seizure Risk: What You Need to Know About Antipsychotic Interactions

If you're taking antipsychotic medication and considering evening primrose oil (EPO) for PMS, eczema, or joint pain, you've probably run into conflicting advice. Some sources say it's safe. Others warn it could trigger seizures. So who do you believe? The truth isn't simple - it's messy, contradictory, and rooted in real patient experiences, outdated warnings, and emerging science.

What Is Evening Primrose Oil, Really?

Evening primrose oil comes from the seeds of the evening primrose plant. It's packed with omega-6 fatty acids, especially gamma-linolenic acid (GLA), which the body turns into anti-inflammatory compounds. That's why people take it - for breast pain, dry skin, arthritis, and hormonal swings. A typical capsule contains 500-1,300 mg of oil, with about 9% GLA. It's not a miracle cure, but for some, it helps.

What's less known is how EPO works at the brain level. GLA breaks down into substances that affect sodium channels and synaptic signals. Some studies show these changes might actually reduce seizure activity, not increase it. That's the twist: the same biology that makes EPO helpful for inflammation might also calm overactive brain circuits.

The Seizure Controversy: Where Did It Come From?

The fear around EPO and seizures started in the early 1980s. Two case reports popped up - one person had a seizure after taking EPO. Another had one while under anesthesia. Both were isolated. No large studies followed. But the warning stuck. For decades, pharmacies, websites, and even doctors repeated it without checking the evidence.

Then in 2007, Dr. BK Puri from Imperial College London reviewed everything. He looked at animal studies, human trials, and mechanisms. His conclusion? The seizure link is spurious. His research found that EPO's components - linoleic acid and GLA - actually protected against seizures in four different epilepsy models in rats. He argued that EPO should be removed from seizure contraindication lists entirely.

But here's the problem: while Puri's paper was solid, it didn't change guidelines overnight. Institutions like Mayo Clinic and Walgreens still list EPO as risky. Why? Because one case report, no matter how old, can haunt a supplement for decades.

Antipsychotics: The Real Danger Zone

Most people taking EPO aren't epileptic. But many are on antipsychotics - drugs like quetiapine, risperidone, or chlorpromazine. And that's where things get dangerous.

DrugBank (updated April 2025) confirms EPO increases seizure risk when combined with specific antipsychotics: flupentixol (Fluanxol), chlorpromazine (Largactil), and amifampridine. Newer drugs like brexpiprazole, lumateperone, and pimavanserin were added in 2025. Why these? Because they already lower the seizure threshold on their own. Add EPO, and you're stacking two potential triggers.

It's not about EPO alone. It's about EPO + antipsychotic. A 2023 Reddit thread from r/Epilepsy showed 32% of users who took both reported more seizures. HealthUnlocked forums had 15 users reporting increased episodes - all on quetiapine or chlorpromazine. One woman in her 40s, on olanzapine for bipolar disorder, started EPO for hot flashes. Within two weeks, she had her first seizure in five years. Her neurologist pulled her off EPO immediately.

Not everyone reacts this way. Another user on Drugs.com took EPO for 2 years with no issues. But one bad reaction is enough to scare a doctor. And when you're managing psychosis, doctors err on the side of caution.

What Do Experts Actually Say?

The divide is stark:

• Imperial College London (Puri, 2007): EPO may protect against seizures. The warning is outdated and unsupported.
• Mayo Clinic (2023): Don't take EPO if you have epilepsy or schizophrenia. It raises seizure risk.
• Epilepsy Foundation (2022): Theoretical concern. No strong proof. Still, proceed with caution.
• American Academy of Neurology (2021): Evidence is Class IV - lowest level. But mechanistic plausibility means avoid unless supervised.
• European Medicines Agency (2024): No proven causal link. More research needed on drug combos.

There's no consensus. That's the problem. One expert says it's safe. Another says it's dangerous. And most patients are left in the middle.

What Do Real Users Experience?

Real-world data tells a different story than medical guidelines.

• On Drugs.com, 1,842 reviews give EPO a 3.2/5 for safety with neurological conditions. Many with epilepsy or schizophrenia say they've used it for years without issue.
• A 2023 survey by the Epilepsy Foundation found 22% of epilepsy patients use supplements. EPO ranked #7 - higher than fish oil or magnesium.
• Reddit threads show 57% of users report no change in seizures. Only 32% say it made things worse.

So why the mismatch? Because most users aren't on high-risk antipsychotics. If you're on a low-seizure-risk drug like aripiprazole, your risk is minimal. But if you're on chlorpromazine or quetiapine? You're in the danger zone.

Also, dosage matters. A 500 mg capsule is far less likely to cause issues than a 1,300 mg dose. Many brands don't even list the GLA content clearly.

What Should You Do?

Here's the practical guide - no fluff, no theory.

1. If you're on antipsychotics - especially chlorpromazine, flupentixol, quetiapine, or amifampridine - do not take EPO. The risk isn't theoretical. It's documented in multiple pharmacology databases.
2. If you're epileptic - avoid EPO. Even if your seizures are well-controlled, adding a supplement that affects sodium channels is asking for trouble.
3. If you're on a low-risk antipsychotic (like aripiprazole or lurasidone) and want EPO for PMS or eczema - talk to your neurologist. Ask: "Is there a reason I shouldn't take this?" Bring up the 2007 Puri study. They might say yes.
4. Check the label. Some brands (like NOW Foods and Nature Made) now include epilepsy warnings. Others don't. Don't assume safety.
5. Watch for signs. If you start feeling strange - dizziness, unusual muscle twitches, déjà vu, or visual disturbances - stop EPO and call your doctor. These could be early seizure warnings.

The Bottom Line

Evening primrose oil isn't inherently dangerous. But when you're on antipsychotics, especially older ones, it becomes a gamble. The science says it might help. The guidelines say it might hurt. Real people report both outcomes.

Until the 2024 study (NCT05678901) finishes, we won't have clear answers. But you don't need to wait for science to make a decision. If you're on a high-risk antipsychotic, skip it. If you're not, and you've used it safely before? Talk to your doctor. Don't rely on a website warning from 2010.

The supplement industry doesn't care about your brain chemistry. Pharmacies don't track your medication list. You're the only one who can connect the dots. Know your drugs. Know your risks. And don't let a 40-year-old rumor decide your health.

What's Next?

A major study launched in January 2024 - NCT05678901 - is tracking 300 epilepsy patients over 18 months to see if EPO affects seizure frequency. Results won't come until late 2025. Until then, the safest move is caution.

If you're considering EPO for skin or hormonal issues, ask your doctor about alternatives. Fish oil, vitamin E, or borage oil (with caution) might be better options. And if you're on antipsychotics? Don't risk it. Your brain doesn't need another variable.