Antiepileptics

MHRA/CHM advice: Antiepileptic drugs in pregnancy: updated advice following comprehensive safety review (January 2021)   
MHRA/CHM advice: Antiepileptic drugs: updated advice on switching between different manufacturers’ products (November 2017)
MHRA/CHM advice: Antiepileptics: risk of suicidal thoughts and behaviour (December 2014) 
Also see BNF: Epilepsy.

  • For indications other than seizure control (eg trigeminal neuralgia) all antiepileptics may be used generically.
  • For further information on the management of epilepsy and choice of antiepileptic drug therapy refer to:
    • SIGN 143 ‘Diagnosis and Management of Epilepsy in Adults’ (www.sign.ac.uk)
    • NICE CG137 guidance on the epilepsies (www.nice.org.uk)
    • ‘Consensus guidelines into the management of epilepsy in adults with an intellectual disability’.
Note: The effectiveness of hormonal contraceptives may be considerably reduced by some antiepileptics; consider this when discussing choice of contraception. Refer to SIGN guidance and to Contraceptives for further information. Women wishing to become pregnant and those who conceive should be counselled by a specialist about possible risks and changes in antiepileptic medication.

Choice of antiepileptic drug monotherapy (from SIGN Guideline 143)

Partial and secondary generalised seizures Primary generalised seizures Uncertain seizure type
• carbamazepine
• sodium valproate
• lamotrigine
• oxcarbazepine
• levetiracetam
• lamotrigine
• levetiracetam
• sodium valproate
As recommended by specialist
• Side-effect and interaction profiles should direct the choice of drug for the individual patient. Refer to the BNF for the wide range of interactions with this group of drugs.
• It is acceptable to titrate up the antiepileptic drug dose more slowly in certain patient groups, eg older people, patients with learning disabilities.
• Some antiepileptic drugs can exacerbate myoclonus, notably gabapentin, carbamazepine, oxcarbazepine and tiagabine.

 

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