|NICE CG137 - The epilepsies: the diagnosis and management of the epilepsies in adults and children in primary and secondary care approved by DTC.
Loss of seizure control has been reported in patients after switching brands of antiepileptic medicines. Continuity of the same brand or the same generic preparation is recommended for patients with seizure disorders. When an antiepileptic is initiated the generic preparation should be prescribed where available, unless there is a particular reason why a brand is required, in which case the GP must be informed when prescribing is transferred to primary care.
Anti-epileptic drugs (AEDs) that are not listed below may be initiated or recommended by tertiary care centres in line with NICE CG 137 / NICE TAs or locally agreed formulary / guidelines. In such cases prescribing responsibility where appropriate may be transferred back to primary care / secondary care.
|Carbamazepine||100mg, 200mg and 400mg tablets
200mg and 400mg MR tablets (Tegretol® Prolonged Release or Carbagen® SR)
200mg and 400mg chewtabs
100mg/5ml oral liquid
|Different preparations may vary in bioavailability to avoid reduced effect or excessive side-effects it may be prudent to avoid changing the formulation.|
|Clonazepam||500micrograms and 2mg tablets|
|Gabapentin||100mg, 300mg and 400mg capsules||600mg and 800mg tablets are NOT approved as they disproportionately more costly than using 2x300mg or 2x 400mg capsules.|
|Lacosamide||50mg,100mg, 150mg, 200mg tablets, 10mg/ml syrup||Only to be initiated by epilepsy specialist clinics or if outside specialist clinics then with advice from tertiary care|
|Lamotrigine||25mg, 50mg, 100mg and 200mg tablets
5mg, 25mg and 100mg dispersible tablets
|Generic and branded products are bioequivalent. When initiating treatment, a generic preparation should be prescribed and this same generic preparation should be continued. If already stabilised on a brand, then the same branded preparation should be continued.|
|Levetiracetam||250mg, 500mg, 750mg and 1g tablets
100mg/ml oral solution
|Oxcarbazepine||150mg, 300mg, 600mg tablets
300mg/5ml oral suspension
25mg,50mg,100mg capsules (Phenytoin Sodium Flynn® capsules)
|BNF states that on the basis of single dose tests there are no clinically relevant differences in bioavailability between available phenytoin sodium tablets and capsules but there may be a pharmacokinetic basis for maintaining the same brand of phenytoin in some patients. Phenytoin has a narrow therapeutic index.
Capsules are preferred as 3 different strengths available allowing for finer dose adjustments.
Tablets only to be prescribed when tablet formulation needs to be continued.
|Pregabalin||25mg, 50mg, 75mg, 100mg, 150mg, 200mg, 225mg and 300mg capsules||See also section 4.1.2 for use in GAD
NOT approved for neuropathic pain in Hertfordshire.
Flat pricing structure - consider most cost effective choice of strengths eg 150mg bd is 33% less costly than 100mg tds
|Sodium valproate||100mg crushable tablets,
200mg and 500mg enteric coated tablets,
200mg/5ml oral solution
200mg, 300mg and 500mg MR tablets (Epilim Chrono®)
50mg, 100mg, 250mg, 500mg, 1g sachets MR granules (Epilim Chronosphere®)
|Valproate should not be used in female children, in female adolescents, in women of childbearing potential and in pregnant women unless other treatments are ineffective or not tolerated. Women of childbearing potential must use effective contraception during treatment and the risks of taking valproate during pregnancy should be explained. See MHRA Drug Safety Update|
|Topiramate||25mg, 50mg,100mg, 200mg tablets
15mg, 25mg, 50mg capsules
|Capsules can be swallowed whole or opened and sprinkled onto soft food and swallowed immediately without chewing.
Generic and branded products are bioequivalent. When initiating treatment, a generic preparation should be prescribed and this same generic preparation should be continued. If already stabilised on a brand, then the same branded preparation should be continued.
|Zonisamide||25mg, 50mg and 100mg capsules||Only to be initiated by epilepsy specialist clinics or if outside specialist clinics then with advice from tertiary care.|