NHS Greater Glasgow & Clyde Area Drug and Therapeutics Committee
Greater Glasgow and Clyde Prescribing
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4 Central nervous system

4.8 Antiepileptic drugs

4.8.1 Control of the epilepsies

Where it is essential in all cases to maintain a patient on a specific brand or manufacturer’s preparation, this is indicated in the relevant Formulary entry. For all other antiepileptic medicines, when being used to treat epilepsy, there is no requirement to be maintained on a specific brand or manufacturer’s preparation, unless the prescriber considers, following a discussion with each individual patient at the next review, that an individual patient's circumstances require the need for continuity of supply of a particular specific manufacturer or brand (e.g. seizure risk, treatment history or other concerns, such as patient anxiety, risk of confusion or dosing errors).

Total Formulary
ACETAZOLAMIDE

Restrictions: Restricted to specialist initiation only.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/5519.htm

BRIVARACETAM

Restrictions: Restricted to adjunctive treatment of partial-onset seizures with or without secondary generalisation in adults and adolescents from 16 years of age with epilepsy. Treatment should be initiated by physicians who have appropriate experience in the treatment of epilepsy.

CARBAMAZEPINE

Prescribing Notes:

When used for epilepsy, Patients should be maintained on a specific brand/preparation and prescribing by brand name should be followed where possible.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/3577.htm

CLOBAZAM

Restrictions: Restricted to specialist initiation only.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/3181.htm

CLONAZEPAM

Restrictions: Restricted to specialist initiation only.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/215610.htm

ESLICARBAZEPINE ACETATE (Zebinix)

Restrictions: Restricted to initiation by specialists in epilepsy.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/203911.htm

ETHOSUXIMIDE

Restrictions: Restricted to specialist initiation only.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/3582.htm

FOSPHENYTOIN

Restrictions: Restricted to specialist initiation only.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/77533.htm

GABAPENTIN

Restrictions: Restricted to specialist initiation only.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/3614.htm

LACOSAMIDE (Vimpat)

Restrictions: Restricted to specialist initiation only. Restricted to patients with refractory epilepsy.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/201445.htm

LAMOTRIGINE

Restrictions: Restricted to specialist initiation only.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/9832.htm

LEVETIRACETAM

Restrictions: Restricted to specialist initiation only. Monotherapy for partial onset seizures (with or without secondary generalisation) in newly diagnosed patients is further restricted to second line treatment when usual first line treatment are ineffective or not tolerated. The infusion is restricted to specialist use only.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/89420.htm

OXCARBAZEPINE (Trileptal) (TABLETS)

Restrictions: Restricted to speialist initiation only. The liquid formulation remains non-formulary.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/86319.htm

PERAMPANEL (Fycompa) (tablets)

Restrictions: Adjunctive treatment of partial-onset seizures with or without secondarily generalised seizures in patients with epilepsy aged 12 years and older is restricted to initiation by specialists in epilepsy.

Prescribing Notes:

For the relevant SMC advice click here

PHENOBARBITAL

Restrictions: Restricted to specialist initiation only.

Prescribing Notes:

Patients should be maintained on a specific manufacturer’s preparation.  Prescriptions should detail the manufacturer of the generic preparation.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/3586.htm

PHENYTOIN

Restrictions: Restricted to specialist initiation only.

Prescribing Notes:

When used for epilepsy, Patients should be maintained on a specific brand/preparation and prescribing by brand name should be followed where possible.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/3596.htm

PREGABALIN

Restrictions: Restricted to initiation only by physicians who have appropriate experience in the treatment of epilepsy and should be used principally in patients who have not benefited from treatment with older anti-convulsants or for whom these drugs are unsuitable because of contraindications, interactions or poor tolerance. Pregabalin has not been accepted by the SMC for use in the treatment of central neuropathic pain and generalised anxiety disorder and is non-Formulary for these indications. The oral solution is also further restricted to those patients who find it difficult to or are unable to swallow tablets.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/89413.htm

PRIMIDONE (Mysoline)

Restrictions: Restricted to specialist initiation only.

Prescribing Notes:

When used for epilepsy, Patients should be maintained on a specific brand/preparation and prescribing by brand name should be followed where possible.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/3592.htm

RUFINAMIDE (Inovelon) (tablets, oral suspension)

Restrictions: Restricted to specialist initiation only in patients who have failed treatment with or are intolerant of other antiepileptic drugs.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/200114.htm

SEMISODIUM VALPROATE

Restrictions: Restricted to specialist initiation for the treatment of mania in bipolar disorder.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/106064.htm

SODIUM VALPROATE

Restrictions: Restricted to specialist initiation only.

Prescribing Notes:

Prescribe by brand name.

Children exposed to valproate in utero are at high risk of developmental disorder and congenital malformations.  For further information and communication materials for prescribers to use in their discussions with patients, see the MHRA Drug Safety Update from February 2016 (click here)

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/3599.htm

TIAGABIN (Gabitril)

Restrictions: Restricted to specialist initiation only.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/106094.htm

TOPIRAMATE

Restrictions: Restricted to specialist initiation only.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/36514.htm

VIGABATRIN (Sabril)

Restrictions: Restricted to specialist initiation only.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/3615.htm

ZONISAMIDE (Zonegran)

Restrictions: Restricted to initiation by physicians who have appropriate experience in the treatment of epilepsy for use in patients who have not responded to established anticonvulsants or for whom these drugs are unsuitable or not tolerated. Use as monotherapy for partial seizure (with or without secondary generalisation) in adults with newly diagnosed epilepsy is not recommended by SMC and remains non-Formulary.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/129258.htm

4.8.2 Drugs used in status epilepticus

Preferred list
MIDAZOLAM (BUCCAL LIQUID)

Restrictions: Buccal midazolam should only be initiated on the advice of a specialist in accordance with agreed local guidelines and following appropriate training of the parent or carer. It may, however, be continued to be prescribed in primary care.

Prescribing Notes:

Buccal midazolam is available as licensed preparation (Buccolam®) or an unlicensed liquid for buccal administration (Epistatus®).  The two preparations are different strengths and may have different doses, therefore are not considered interchangeable.  In light of these differences and the associated risks, any agreed change of preparation in existing patients would require careful management by all involved.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/129773.htm

Total Formulary
FOSPHENYTOIN

Restrictions: Restricted to specialist initiation only.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/77533.htm

PARALDEHYDE

Restrictions: Restricted to specialist initiation only.

PHENYTOIN

Restrictions: Restricted to specialist initiation only.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/3628.htm

CLONAZEPAM

Restrictions: Restricted to specialist initiation only.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/3620.htm

4.8.3 Febrile convulsions

Total Formulary
PARACETAMOL (infusion)

Restrictions: The infusion should be only be used when the IV route can be clinically justified over other routes of administration. The dose of the IV preparation may need to be reduced in the presence of risk factors (e.g. low weight or renal impairment).

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/3630.htm