East Sussex - Better Together
NHS

4.8.1 Control of the epilepsies

MHRA drug safety update (April 2018):Valproate medicines (Epilim▼, Depakote▼): contraindicated in women and girls of childbearing potential unless conditions of Pregnancy Prevention Programme are met

Please see: MHRA advice: Antiepileptic products – changing brands

Category 1

Category 2

Category 3

Phenytoin, carbamazepine, phenobarbital, primidone

Doctors are advised to ensure that their patient is maintained on a specific manufacturer’s product.

 

Valproate, lamotrigine, perampanel, retigabine, rufinamide, clobazam, clonazepam, oxcarbazepine, eslicarbazepine, zonisamide, topiramate.

The need for continued supply of a particular manufacturer’s product should be based on clinical judgement and consultation with patient and/or carer taking into account factors such as seizure frequency and treatment history

Levetiracetam, lacosamide, tiagabine, gabapentin, pregabalin, ethosuximide, vigabatrin.

It is usually unnecessary to ensure that patients are maintained on a specific manufacturer’s product unless there are specific concerns such as patient anxiety, and risk of confusion or dosing errors.

MHRA Safety Update: potential risk of serious skin reactions.

Doctors are advised to ensure that their patient is maintained on a specific manufacturer’s product.

Controlled release preparations of carbamazepine are preferable to standard release formulations.

Pack
56 tablet
Pack
56 tablet
Pack
56 tablet
Pack
56 tablet
Pack
56 tablet
Pack
56 tablet
Pack
56 tablet
Pack
5 suppository
Pack
5 suppository
Pack
300 ml

Titration upwards to a stable maintenance dose should be undertaken by the specialist. Once the patient is on a stable dose (at least 3 months after starting treatment) prescribing responsibility can be passed over to GPs.

Pack
28 tablet
Pack
28 tablet
Pack
28 tablet
Pack
28 tablet
Pack
28 tablet
Pack
28 tablet

Doctors are advised to ensure that their patient is maintained on a specific manufacturer’s product.

Phenytoin has a narrow therapeutic index and the relationship between dose and plasma levels is non-linear. A small increase in dose may produce a large increase in plasma concentration with acute toxic side effects.

 

Pack
28 capsule
Pack
28 capsule
Pack
28 tablet
Pack
84 capsule
Pack
28 tablet
Pack
28 capsule

90mg of phenytoin (chewable tablets or suspension) is considered equivalent to 100mg of phenytoin  sodium (tablets or capsules)

Pack
112 tablet

90mg of phenytoin (chewable tablets or suspension) is considered equivalent to 100mg of phenytoin  sodium (tablets or capsules)

Pack
500 ml

MHRA drug safety update (April 2018):Valproate medicines (Epilim▼, Depakote▼): contraindicated in women and girls of childbearing potential unless conditions of Pregnancy Prevention Programme are met

Pack
100 tablet
Pack
100 tablet
Pack
300 ml
Pack
5 ampoule
Pack
100 tablet
Pack
100 tablet (10 x 10 tablets)
Pack
100 tablet (10 x 10 tablets)
Pack
100 tablet (10 x 10 tablets)

Women and girls of childbearing potential should be informed that topiramate is associated with a risk of foetal malformations and can impair the effectiveness of hormonal contraceptives. Ensure they are offered suitable contraception.

Pack
60 capsule
Pack
28 tablet
Pack
60 capsule
Pack
28 tablet
Pack
60 capsule
Pack
28 tablet
Pack
28 tablet

Patients prescribed vigabatrin need monitoring for visual field defects, with visual field assessment carried out every 6 months. 

Pack
100 tablet
Pack
50 sachet
  • First Line Drugs
  • Second Line Drugs
  • Specialist Initiated Drugs
  • Specialist Only Drugs
  • Mixed Status