Antiepileptics

MHRA advice: Antiepileptic drugs in pregnancy: updated advice following comprehensive safety review (January 2021) (www.gov.uk).
MHRA advice: Antiepileptic drugs: updated advice on switching between different manufacturers’ products (November 2017) (www.gov.uk).
MHRA advice: Antiepileptics: risk of suicidal thoughts and behaviour (December 2014) (www.gov.uk).
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.

Control of epilepsies

Status epilepticus (Formulary)