4.8.1 Control of the epilepsies
Please see: MHRA advice: Antiepileptic products – changing brands
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Category 1 |
Category 2 |
Category 3 |
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Phenytoin, carbamazepine, phenobarbital, primidone Doctors are advised to ensure that their patient is maintained on a specific manufacturer’s product.
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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. |
| Pack |
|---|
| 14 tablet |
| Pack |
|---|
| 56 tablet |
| Pack |
|---|
| 56 tablet |
| Pack |
|---|
| 56 tablet |
| Pack |
|---|
| 56 tablet |
| Pack |
|---|
| 300 ml |
| Pack |
|---|
| 10 vial |
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 |
Treatment must be started and stabilised in a Tertiary epilepsy service, with prescribing in accordance with NICE TA753
| Pack |
|---|
| 14 tablet |
| 28 tablet |
| Pack |
|---|
| 14 tablet |
| Pack |
|---|
| 28 tablet |
| Pack |
|---|
| 14 tablet |
| 28 tablet |
| Pack |
|---|
| 14 tablet |
| 28 tablet |
| Pack |
|---|
| 14 tablet |
| Pack |
|---|
| 14 tablet |
| 28 tablet |
| Pack |
|---|
| 90 capsule |
| Pack |
|---|
| 90 capsule |
| Pack |
|---|
| 90 capsule |
| Pack |
|---|
| 100 tablet |
| Pack |
|---|
| 100 tablet |
| Pack |
|---|
| 56 tablet |
| Pack |
|---|
| 56 tablet |
| Pack |
|---|
| 56 tablet |
| Pack |
|---|
| 56 tablet |
| Pack |
|---|
| 30 tablet |
| Pack |
|---|
| 56 tablet |
| Pack |
|---|
| 56 tablet |
| Pack |
|---|
| 56 tablet |
| Pack |
|---|
| 60 tablet |
| Pack |
|---|
| 60 tablet |
| Pack |
|---|
| 60 tablet |
| Pack |
|---|
| 60 tablet |
| Pack |
|---|
| 300 ml |
| Pack |
|---|
| 50 tablet |
| Pack |
|---|
| 50 tablet |
| Pack |
|---|
| 50 tablet |
| Pack |
|---|
| 250 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 |
| Pack |
|---|
| 56 capsule |
| Pack |
|---|
| 56 capsule |
| Pack |
|---|
| 56 capsule |
| Pack |
|---|
| 56 capsule |
| Pack |
|---|
| 56 capsule |
| Pack |
|---|
| 56 capsule |
| Pack |
|---|
| 56 capsule |
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) |
| Pack |
|---|
| 100 tablet |
| Pack |
|---|
| 100 tablet |
| Pack |
|---|
| 100 tablet |
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 or Recommended Drugs
- Specialist Initiated Drugs with Shared Care Guidelines
- Specialist Only Drugs
- Mixed Status