| Anti-epileptics for the treatment of epilepsy should be initiated by a specialist. |
General information
- Refer to NICE NG217 Epilepsies in children, young people and adults.
- Category 3 anti-epileptic drugs should be initiated generically, i.e. brivaracetam, ethosuximide, gabapentin, lacosamide, levetiracetam, pregabalin, tiagabine, vigabatrin.
- Patients currently on branded levetiracetam or lacosamide should be reviewed and switched to the generic, on a case-by-case basis and with patient agreement. Support materials are available.
- Gradual withdrawal of anti-epileptic drugs can be considered with caution, for some patients, after a prolonged period of seizure freedom (at least 2 years) but note implications for driving. Specialist advice should always be sought to estimate the individual risk of seizure recurrence on withdrawal of AED treatment.
- The dose of AED may need to be adjusted in women who commence or stop oral contraceptives, – see FSRH.
- Women who become pregnant whilst taking antiepileptics for epilepsy must not stop this medication abruptly but should be advised to continue taking it whilst specialist opinion is immediately sought.
- Patients taking multiple tablets of lamotrigine (generic or Lamictal®) should be reviewed to consider switching to the equivalent dose of higher strength tablets e.g. 100mg x 2 tablets to 200mg x 1 tablet. Only switch patients that are stable on an established effective dose that controls seizures.
- Midazolam buccal liquid should be prescribed by brand name to reduce risk of confusion between different preparations.
Safety considerations with AEDs
- The MHRA’s regulatory measures for valproate and topiramate include a requirement that valproate or topiramate must not be used in any woman or girl of child-bearing potential unless there is a Pregnancy Prevention Programme in place. Safety and educational materials are available, see valproate and topiramate.
- Review by two specialists is required for initiating valproate in patients under 55 years of age but is not required for men (or males) currently taking valproate, see MHRA.
- See also MHRA safety recommendations: