North East and North Cumbria
ICS Formulary
 
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4 Central nervous system
04-08-01 Control of epilepsy

The MHRA recommend that patients on certain antiepileptic drugs remain on the same brand where possible. In order to help decide which anti-epileptics may or may not be switched the MHRA have classified anti-epileptics in to 3 categories.

Category 1 - the patient should be maintained on a specific manufacturer’s product (carbamazepine, phenobarbital and phenytoin)

Category 2 - 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 (clobazam, clonazepam, eslicarbazepine acetate, lamotrigine, oxcarbazepine, perampanel, retigabine, rufinamide, sodium valproate, topiramate, and zonisamide).

Category 3 - usually unnecessary to ensure that patients are maintained on a specific manufacturer’s product unless there are specific reasons such as patient anxiety and risk of confusion or dosing errors (acetazolamide, brivaracetam, ethosuximide, gabapentin, lacosamide, levetiracetam, pregabalin, stiripentol, and vigabatrin).


Acetazolamide
Formulary

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Brivaracetam
Formulary
  • Approved for use as adjunctive therapy in patients with severe/intractable partial onset seizures e.g. a sezuire frequency of 1 per week following failure of first-line adjunctive therapy. Response must be assessed within 3-6 months before transferring prescribing to primary or stopping treatment, as appropriate.

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Cannabidiol Epidyolex®
Formulary
  • 100mg/1mL oral solution
    • Approved for use in combination with clobazam for treating seizuires associated with Dravet syndrome in people aged 2 years and older
    • Approved for use in combination with clobazam for treating seizures associated with Lennox-Gastaut syndrome
    • Approved as an add-on treatment option for seizures caused by tuberous sclerosis complex in people aged 2 years and over - in line with NICE TA873.
Link  NICE TA614: Cannabidiol with clobazam for treating seizures associated with Dravet syndrome
Link  NICE TA615: Cannabidiol with clobazam for treating seizures associated with Lennox–Gastaut syndrome
Link  NICE TA873: Cannabidiol for treating seizures caused by tuberous sclerosis complex

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Carbamazepine
Formulary
  • Carbamazepine 200mg and 400mg MR tablets (Tegretol® retard) are available on consultant request for those in whom conventional carbamazepine has been shown to be unsuitable Green Traffic Light

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Carbamazepine Suppositories
Formulary

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Clobazam
Formulary

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Clonazepam
Formulary
  • Clonazepam 500microgram in 5ml sugar-free oral solution is also approved unlicensedunlicensed

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Eslicarbazepine
Formulary
  • Approved for use by specialists only in those patients for whom intolerance of carbamazepine is a major concern and when use of this agent is more cost effective than alternatives available.

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Ethosuximide
Formulary

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Fenfluramine Fintepla®
Formulary

Oral solution: 2.2mg/mL

Link  NICE TA808: Fenfluramine for treating seizures associated with Dravet syndrome

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Gabapentin
Formulary
  • Note: gabapentin 250mg in 5ml is also approved unlicensedunlicensed.
Link  MHRA Drug Safety Alert (Oct 2017): Gabapentin (Neurontin): risk of severe respiratory depression

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Lacosamide
Formulary
  • Only approved on advice from consultant neurologists, in patients that are refractory to treatment with other drugs.

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Lamotrigine
Formulary

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Levetiracetam
Formulary

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Oxcarbazepine
Formulary

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Perampanel
Formulary
  • NETAG approved for partial (focal) seizure epilepsy only when other treatment  options recommended by NICE have been tried or fully considered.
Link  NTAG - Perampanel (Fycompa®) for epilepsy

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Phenobarbital
Formulary

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Phenobarbital INJECTION
Formulary

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Phenytoin
Formulary
  • Note: phenytoin 30mg in 5ml suspension (base) – 90mg (15ml) is equivalent to one 100mg phenytoin sodium capsule 250mg in 5ml injection (sodium salt).

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Piracetam
Formulary

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Pregabalin
Formulary
  • Approved for specialist advice in the management of treatment resistant epilepsy. 
  • Also approved as a second line agent for General Anxiety Disorder. Although treatment can be given 2-3 times daily, it is more cost effective to give as a twice daily dose. 
Link  MHRA Drug Safety Update (Apr 2022): Pregabalin (Lyrica): findings of safety study on risks during pregnancy
Link  MHRA Drug Safety Update (Feb 2021): Pregabalin (Lyrica): reports of severe respiratory depression

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Primidone 
Formulary

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Rufinamide
Formulary
  • Approved for limited use as a second or third-line treatment in patients with Lennox-Gastaut syndrome and related encephalopathies.
  • Should only be used on the advice of paediatric neurologists and other neurologists specialising in the treatment of epilepsy.

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Sodium Valproate
Formulary
  • Note: sodium valproate 500mg & 1000mg MR granules (Episenta®) - for possible use in those who have difficulty swallowing sodium valproate tablets. May be more convenient to use than large volumes of liquid formulations.
  • Valproate▼ must no longer be prescribed to women and girls of childbearing potential unless there is no alternative and they are on the Pregnancy Prevention Programme (PPP) Amber

▼ BLACK TRIANGLE IN FEMALES

Valproate must no longer be prescribed to women and girls of
childbearing potential unless there is no alternative and they are on the
Pregnancy Prevention Programme (PPP)

For information relating to alerts regarding valproate, including Drug Safety Updates and links to PPP materials, please use the following link:

MHRA Drug Safety Updates (valproate)

Link  Valproate medicines: Pregnancy Prevention Programme materials
Link  Local Shared Care guideline in TEWV to support Valproate Pregnancy Prevention Programme

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Sodium Valproate▼ Injection
Formulary

Valproate must no longer be prescribed to women and girls of
childbearing potential unless there is no alternative and they are on the
Pregnancy Prevention Programme (PPP)

For information relating to alerts regarding valproate, including Drug Safety Updates and links to PPP materials, please use the following link:

MHRA Drug Safety Updates (valproate)


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Stiripentol
Formulary
  • For use as adjunctive therapy of refractory generalised tonicclonic seizures in children with severe myoclonic epilepsy in infancy.

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Tiagabine
Formulary

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Topiramate
Formulary

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Vigabatrin
Formulary
Link  North of Tyne, Gateshead and North Cumbria - Vigabatrin Shared Care Guideline

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Zonisamide
Formulary

 

    • For use only in patients that are refractory to treatment with other drugs on the recommendation of a specialist

 

    • Use in children is unlicensedunlicensed.

 


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