MHRA advice: Antiepileptic drugs in pregnancy: updated advice following comprehensive safety review (January 2021) (  
MHRA advice: Antiepileptic drugs: updated advice on switching between different manufacturers’ products (November 2017) (
MHRA 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 (
    • NICE CG137 guidance on the epilepsies (
    • 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.