Other antiepileptics (Formulary)

TAM (Treatments and Medicines) NHS Highland
NHS Highland
  • 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)
  • SPS: What is a suitable combined oral contraceptive pill in a patient who is taking hepatic enzyme-inducing drugs, such as carbamazepine, phenytoin, rifampicin or rifabutin? (May 2019)
  • BNF: Epilepsy.

BRIVARACETAM

Therapy notes

Formulation and dosage details

Formulation:

Tablets 10mg, 25mg, 50mg, 75mg, 100mg (specialist initiation only)

Dosage:

As per SMC 1160/16: Adjunctive therapy in the treatment of partial-onset seizures with or
without secondary generalisation in adult and adolescent patients from 16 years of age with
epilepsy.
SMC restriction: for use in patients with refractory epilepsy and treatment should be initiated by
physicians who have appropriate experience in the treatment of epilepsy. 

Formulation and dosage details

Formulation:

Oral solution 50mg/5mL (specialist initiation only)

Dosage:

As per SMC 1160/16: Adjunctive therapy in the treatment of partial-onset seizures with or
without secondary generalisation in adult and adolescent patients from 16 years of age with
epilepsy.
SMC restriction: for use in patients with refractory epilepsy and treatment should be initiated by
physicians who have appropriate experience in the treatment of epilepsy. 

Formulation and dosage details

Formulation:

Solution for infusion 50mg/5mL (specialist initiation only)

Dosage:

As per SMC 1160/16: Adjunctive therapy in the treatment of partial-onset seizures with or
without secondary generalisation in adult and adolescent patients from 16 years of age with
epilepsy.
SMC restriction: for use in patients with refractory epilepsy and treatment should be initiated by
physicians who have appropriate experience in the treatment of epilepsy. 

CENOBAMATE

Therapy notes

  • Cenobamate is very persistent in aquatic systems, any unused medicines should be returned to Pharmacy for disposal.
  • Women of childbearing potential should use effective contraception during treatment and for 4 weeks after last dose.

Formulation and dosage details

Formulation:

Film-coated tablets 12·5mg, 25mg, 50mg, 100mg, 150mg, 200mg (specialist initiation only)

Dosage:

As per SMC2408: for the adjunctive treatment of focal-onset seizures with or without secondary generalisation in adult patients with epilepsy who have not been adequately controlled despite treatment with at least 2 anti-epileptic medicinal products.
SMC restriction: in patients with drug-resistant epilepsy as a second-line adjunctive anti-seizure medicine, after the failure of the first adjunctive anti-seizure medicine.

Local Prescribing Recommendations:

  • Initiation: Specialist initiation only by Epilepsy Service
  • Patient education and counselling: Epilepsy Service
  • Titration to target dose: Epilepsy Service
  • Maintenance dose: Primary care 
  • Monitoring: Adjustment of dose and monitoring of clinical response will be carried out by the Epilepsy Service. 
  • Review: Frequent review by Epilepsy Service in the first 3 to 6 months, then as needed. 
  • Discontinuation: Decision to discontinue can be made in primary care, however this is expected to be in consultation with the Epilepsy Service for ongoing advice. 

CLOBAZAM

Therapy notes


  • MHRA advice: Drug-name confusion: reminder to be vigilant for potential errors (January 2018).
  • MHRA/CHM advice: Benzodiazepines and opioids: reminder of risk of potentially fatal respiratory depression (March 2020). 

Formulation and dosage details

Formulation:

Tablets 10mg (specialist initiation only)

Dosage:

Clobazam 10mg is useful in catamenial epilepsy and for the prevention of further seizures in patients who tend to have seizure clusters. It should only be prescribed for epilepsy and the prescription must be endorsed 'SLS'.

CLONAZEPAM

Therapy notes

  • MHRA advice: Benzodiazepines and opioids: reminder of risk of potentially fatal respiratory depression (March 2020).
  • MHRA advice: Drug-name confusion: reminder to be vigilant for potential errors (January 2018).
  • MHRA advice: Drugs and driving: concentration limits to be set for certain controlled drugs in a new legal offence (December 2014).

Formulation and dosage details

Formulation:

Tablets 500 micrograms, 2mg (specialist initiation only)

Formulation and dosage details

Formulation:

Oral solution 500 micrograms/5mL (specialist initiation only)

ESLICARBAZEPINE

Therapy notes

  • SMC592/09: as adjunctive therapy in adults with partial-onset seizures with or
    without secondary generalisation.
    SMC restriction: patients with highly refractory epilepsy who have been heavily pre-treated
    and remain uncontrolled with existing anti-epileptic drugs. 

Formulation and dosage details

Formulation:

Tablets 800mg (specialist initiation only)

ETHOSUXIMIDE

Therapy notes

Formulation and dosage details

Formulation:

Capsules 250mg (specialist initiation only)

GABAPENTIN

Therapy notes

  • MHRA advice: Pregabalin (Lyrica), gabapentin (Neurontin) and risk of abuse and dependence: new scheduling requirements (April 2019)
  • MHRA advice: Gabapentin (Neurontin®): risk of severe respiratory depression (October 2017)
  • The levels of propylene glycol, acesulfame K and saccharin sodium may exceed the recommended WHO daily intake limits if high doses of gabapentin oral solution (Rosemont brand) are given to adolescents or adults with low body-weight (39 to 50kg). Consult product literature.

Formulation and dosage details

Formulation:

Capsules (CD schedule 3) 100mg, 300mg, 400mg (specialist initiation only)

Formulation and dosage details

Formulation:

Tablets (CD schedule 3) 600mg (specialist initiation only)

LACOSAMIDE

Therapy notes

Formulation and dosage details

Formulation:

Tablets 50mg, 100mg, 150mg, 200mg (specilialist initiation only)

Dosage:

As per SMC 1301/18: as adjunctive therapy in the treatment of partial-onset seizures with or without secondary generalisation in adolescents and children from 4 years of age with epilepsy.
SMC restriction: patients with refractory epilepsy. Treatment should be initiated by physicians who have appropriate experience in the treatment of epilepsy. 

LEVETIRACETAM

Therapy notes

Formulation and dosage details

Formulation:

Tablets 250mg, 500mg, 750mg, 1 gram (specialist initiation only)

Formulation and dosage details

Formulation:

Oral solution 100mg/mL (specialist initiation only)

Dosage:

Note: Levetiracetam oral solution 100mg/1mL; risk of medication errors associated with overdose.

  • always prescribe the dose in mg with mL equivalence based on the correct age and body weight
  • advise the patient and/or care-giver on how to measure the prescribed dose
  • see full advice at UCB Pharma.

OXCARBAZEPINE

Therapy notes

Formulation and dosage details

Formulation:

Tablets 150mg, 300mg, 600mg (specialist initiation only)

PERAMPANEL

Therapy notes

  • SMC819/12: Adjunctive treatment of partial-onset seizures with or without
    secondarily generalised seizures in patients with epilepsy aged 12 years and older.
    SMC restriction: use as a second-line adjunctive treatment in patients with refractory partial
    onset epilepsy. Treatment should be initiated only by physicians who have appropriate
    experience in the treatment of epilepsy.

Formulation and dosage details

Formulation:

Tablets 2mg, 4mg, 6mg, 8mg, 10mg, 12mg (specialist initiation only)

PHENOBARBITAL

Therapy notes

  • Switching between formulations: Different formulations of oral preparations may vary in bioavailability. Patients should be maintained on a specific manufacturer's product.
  • In children: The RCPCH and NPPG position statement Choosing an Oral Liquid Medicine for Children states that recommended practice in the UK is to use an ethanol-free unlicensed 50 mg/5 mL liquid for the oral administration of phenobarbital to children when an oral liquid is required. Phenobarbital Elixir BP (15 mg/5 mL) contains 38% v/v of ethanol (alcohol), and so there is potential for accumulation when ingested repeatedly, especially in young children with low or immature metabolic capacity.

Formulation and dosage details

Formulation:

Tablets (CD schedule 3) 15mg, 30mg, 60mg (specialist use only)

Formulation and dosage details

Formulation:

Oral solution 50mg/5mL (CD schedule 3) unlicensed (specialist initiation only)

  • An unlicensed sugar-free, alcohol-free 50mg/5mL oral solution is available from Rosemont Pharmaceuticals

Formulation and dosage details

Formulation:

Solution for injection (CD schedule 3) 30mg/mL, 200mg/mL (specialist initiation only)

PREGABALIN

Therapy notes

  • MHRA advice:Pregabalin (Lyrica): reports of severe respiratory depression (February 2021)
  • MHRA advice: Pregabalin (Lyrica), gabapentin (Neurontin) and risk of abuse and dependence: new scheduling requirements (April 2019) 

Formulation and dosage details

Formulation:

Capsules (CD schedule 3) 25mg, 50mg, 75mg, 100mg, 150mg, 200mg, 225mg, 300mg (specialist initiation only)

Formulation and dosage details

Formulation:

Oral solution (CD schedule 3) 100mg/5mL (specialist initiation only)

PRIMIDONE

Therapy notes

Formulation and dosage details

Formulation:

Tablets 250mg (specialist initiation only)

STIRIPENTOL

Therapy notes

Formulation and dosage details

Formulation:

Hard capsule 250mg, 500mg (specialist initiation only)

Dosage:

As per SMC 524/08: In conjunction with clobazam and valproate as adjunctive therapy of refractory generalised tonic-clonic seizures in patients with severe myoclonic epilepsy in infancy (SMEI; Dravet’s syndrome) whose seizures are not adequately controlled with clobazam and valproate.

Formulation and dosage details

Formulation:

Powder for oral suspension in sachet 250mg, 500mg (specialist initiation only)

Dosage:

As per SMC 524/08: In conjunction with clobazam and valproate as adjunctive therapy of refractory generalised tonic-clonic seizures in patients with severe myoclonic epilepsy in infancy (SMEI; Dravet’s syndrome) whose seizures are not adequately controlled with clobazam and valproate.

ZONISAMIDE

Therapy notes

Formulation and dosage details

Formulation:

Capsules 25mg, 50mg, 100mg (specialist initiation only)