Control of the Epilepsies

Brivaracetam

Specialist initiation (S1)

BRIVARACETAM

  • SMC restrictionRestricted 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.
  • MHRA Category 3.

Carbamazepine and Related Drugs

Specialist initiation (S1)

CARBAMAZEPINE

  • Hepatic enzyme inducing agent and reduces the effectiveness of hormonal contraceptives.
  • MHRA Category 1.

ESLICARBAZEPINE

  • Hepatic enzyme inducing agent and reduces the effectiveness of hormonal contraceptives.
  • SMC restrictionas adjunctive therapy in adults with partial-onset seizures with or without secondary generalisation, with highly refractory epilepsy who have been heavily pre-treated and remain uncontrolled with existing anti-epileptic drugs.
  • MHRA Category 2.

OXCARBAZEPINE

  • Hepatic enzyme inducing agent and reduces the effectiveness of hormonal contraceptives.
  • MHRA Category 2.

Cenobamate

Specialist initiation (S1)

CENOBAMATE

  • SMC restriction: Restricted to specialist initiation in patients with drug-resistant epilepsy as a second-line adjunctive anti-seizure medicine, after the failure of the first adjunctive anti-seizure medicine.

Ethosuximide

Specialist initiation (S1)

ETHOSUXIMIDE

  • MHRA Category 3.

Gabapentin

Specialist initiation (S1)

GABAPENTIN

  • MHRA Category 3.

Lacosamide

Specialist initiation (S1)

LACOSAMIDE

  • SMC restriction: adjunctive therapy in the treatment of partial-onset seizures with or without secondary generalisation in patients with refractory epilepsy.
  • MHRA Category 3.

Lamotrigine

Specialist initiation (S1)

LAMOTRIGINE

  • Combined oral contraceptives can affect the concentration of lamotrigine.
  • Lamotrigine use has been associated with skin reactions and blood dyscrasias.
  • MHRA Category 2.

Levetiracetam

Specialist initiation (S1)

LEVETIRACETAM

  • MHRA Category 3.

Perampanel

Specialist initiation (S1)

PERAMPANEL

  • SMC restriction: for use as a second-line adjunctive treatment in patients with refractory partial onset epilepsy.
  • MHRA Category 2.

Phenobarbital and other barbiturates

Specialist initiation (S1)

PHENOBARBITAL

  • Hepatic enzyme inducing agent and reduces the effectiveness of hormonal contraceptives.
  • MHRA Category 1.

Phenytoin

Specialist initiation (S1)

PHENYTOIN

  • Hepatic enzyme inducing agent and reduces the effectiveness of hormonal contraceptives.
  • MHRA Category 1.

Primidone

Specialist initiation (S1)

PRIMIDONE

  • Hepatic enzyme inducing agent and reduces the effectiveness of hormonal contraceptives.
  • MHRA Category 1.

Rufinamide

Specialist initiation (S1)

RUFINAMIDE

  • Hepatic enzyme inducer and reduces the effectiveness of hormonal contraceptives.
  • SMC restrictionas adjunctive therapy in the treatment of seizures associated with Lennox-Gastaut syndrome (LGS), in patients who have failed treatment with, or are intolerant to, other antiepileptic drugs.
  • MHRA Category 2.

Topiramate

Specialist initiation (S1)

TOPIRAMATE

  • Hepatic enzyme inducing agent and reduces the effectiveness of hormonal contraceptives.
  • MHRA Category 2.

Valproate

Specialist initiation (S1)

SODIUM VALPROATE

  • Sodium valproate is associated with a significant risk of birth defects and developmental disorders in children exposed to valproate in utero.
  • MHRA Category 2.

MHRA VALPROATE AND DEVELOPMENTAL DISORDERS ALERT

IMPORTANT NEW RESTRICTIONS MHRA (JANUARY 2024): Additional safety measures include changes to initiation of Valproate and ongoing prescription review for MALES and FEMALES.
Valproate must not be prescribed to women/girls of childbearing potential unless enrolled in pregnancy prevention programme (PPP).

Source: MHRA Drug Safety Update Jan 2024: New safety and educational materials to support regulatory measures in men and women under 55 years of age.

MHRA Resources: MHRA information pagePatient GuidePatient cardPatient Information LeafletHealthcare Professional GuideAnnual Risk Acknowledgement Form for female patients and Risk Acknowledgement Form for male patients starting valproate

 

Vigabatrin

Specialist initiation (S1)

VIGABATRIN

  • MHRA Category 3.

Zonisamide

Specialist initiation (S1)

ZONISAMIDE

  • SMC restriction: as adjunctive therapy in adult patients with partial seizures, with or without secondary generalisation.
  • Zonisamide should be initiated 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 an older anti-convulsant drug, or for whom these drugs are unsuitable because of contraindications, interaction or poor tolerance.
  • MHRA Category 2.

Benzodiazepines

Specialist initiation (S1)

CLONAZEPAM

  • MHRA Category 2.

CLOBAZAM

  • Licensed for adjunctive therapy only.
  • MHRA Category 2.

NHSL Joint Adult Formulary Key

To indicate the category of a formulary medicine, updated sections adopt the following key:

Preferred list (P): First-line formulary choices.

Total list (T): Alternative choices when preferred list options not effective/not tolerated, or not indicated.

Specialist initiation (S1): Specialist initiation, or on the advice of a Consultant or Specialist Practitioner in this therapeutic area. Continuation in primary care is acceptable.

Specialist use only (S2): Supply via hospital, Homecare Service or a hospital based prescription (HBP) for dispensing by community pharmacy. Not prescribed in primary care setting.

Editorial Information

Author(s): NHSL.

Version: Please refer to the introduction section for an explanation of the review dates above.

Approved By: ADTC