North Staffordshire Joint Formulary
North Staffordshire Clinical Commissioning Group
Stoke-on-Trent Clinical Commissioning Group

 
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4 Central nervous system
04-08-01 Control of epilepsy

Category

Antiepileptic drugs

MHRA Advice

1

phenytoin, carbamazepine, phenobarbital, primidone

For these drugs, doctors are advised to ensure that their patient is maintained on a specific manufacturer’s product

2

valproate, lamotrigine, perampanel, retigabine, rufinamide, clobazam, clonazepam, oxcarbazepine, eslicarbazepine, zonisamide, topiramate

For these drugs, the need for continued supply of a particular manufacturer’s product should be based on clinical judgement and consultation with patient and/or carer, taking into account factors such as seizure frequency and treatment history

3

levetiracetam, lacosamide, tiagabine, gabapentin, pregabalin, ethosuximide, vigabatrin  

For these drugs, it is usually unnecessary to ensure that patients are maintained on a specific manufacturer’s product unless there are specific reasons such as patient anxiety and risk of confusion or dosing errors


Cannabidiol Epidyolex®
Formulary

Restriction: In line with NICE Guidance only

  • For treating seizures associated with Lennox-Gastaut syndrome [adjunctive treatment with clobazam] specialist use only
  • For treating seizures associated with Dravet syndrome [adjunctive treatment with clobazam] specialist use only

 

Link  NICE TA614: Cannabidiol with clobazam for treating seizures associated with Dravet syndrome
Link  NICE TA615: Cannabidiol with clobazam for treating seizures associated with Lennox–Gastaut syndrome
 

Controlled Drug  Red View adult BNF  View SPC online  View childrens BNF  HCD
Carbamazepine MR
Formulary

Carbagen SR Tablets 200mg - Discontinued
Carbagen SR Tablets 400mg - Discontinued
Tegretol MR Tablets 200mg
Tegretol MR Tablets 400mg

Restriction: Initiation and stabilisation by specialist
Maintain patient on specific manufacturer's products

Additional Information July 2006

  • Carbamazepine suppositories are licensed for short-term treatment (maximum 7 days) only when oral therapy is temporarily not possible.
  • Carbamazepine 125mg suppositories should be considered equivalent to 100mg tablets but plasma monitoring is recommended.


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Clobazam
Formulary

Clobazam Oral Suspension 5mg/5ml - For patients with swallowing difficulty 
Clobazam Oral Suspension 10mg/5ml - For patients with swallowing difficulty 
Clobazam Tablets 10mg

Not NHS except on specialist recommendation for epilepsy and endorsed 'SLS'.

Restriction: Initiation and stabilisation by specialist
Unnecessary to maintain patient on specific manufacturer's product.

HCD - Liquid Suspension


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Clonazepam
Formulary

Clonazepam Tablets 500mcg 
Clonazepam Tablets 2mg
Clonazepam Oral solution 500mcg/5ml
Clonazepam Oral Solution 2mg/5ml 

Restriction: Initiation and stabilisation by specialist
Unnecessary to maintain patient on specific manufacturer's products.


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Eslicarbazepine Zebinix®
Formulary

Eslicarbazepine Tablets 200mg
Eslicarbazepine Tablets 800mg 

Restriction: Initiation and stabilisation by specialist
Unnecessary to maintain patient on specific manufacturer's products.


Amber View adult BNF  View SPC online  View childrens BNF
Ethosuximide
Formulary

Ethosuximide Capsules 250mg
Ethosuximide Oral Solution 250mg/5ml

Restriction: Initiation and stabilisation by specialist
Unnecessary to maintain patient on specific manufacturer's products.


Amber View adult BNF  View SPC online  View childrens BNF
Gabapentin
Formulary

Gabapentin Capsules 100mg
Gabapentin Capsules 300mg
Gabapentin Capsules 400mg
Gabapentin Tablets 600mg
Gabapentin Oral Solution 50mg/ml

CD As of the 1st April 2019 Gabapentin is re-classified as a Schedule 3 Controlled Drug

Restriction: Initiation and stabilisation by specialist
Unnecessary to maintain patient on specific manufacturer's products.


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Lacosamide  Vimpat®
Formulary

Vimpat 50 mg film-coated tablets
Vimpat 100 mg film-coated tablets
Vimpat 150 mg film-coated tablets
Vimpat 200 mg film-coated tablets
Vimpat Syrup 10mg/ml

Restriction: Initiation and stabilisation by specialist
Unnecessary to maintain patient on specific manufacturer's products.


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Lamotrigine
Formulary

Lamotrigine Tablet 25mg 
Lamotrigine Tablet 50mg 
Lamotrigine Tablet 100mg 
Lamotrigine Tablet 200mg 
Lamotrigine Tablet Dispersible 5mg S/F 
Lamotrigine Tablet Dispersible 25mg S/F
Lamotrigine Tablet Dispersible 100mg S/F 

Restriction: Initiation and stabilisation by specialist
Unnecessary to maintain patient on specific manufacturer's products.


Amber View adult BNF  View SPC online  View childrens BNF
Levetiracetam
Formulary

Levetiracetam Tablet 250mg 
Levetiracetam Tablet 500mg 
Levetiracetam Tablet 750mg 
Levetiracetam Tablet 1gram
Levetiracetam Oral Solution 500mg/5ml S/F

Restriction: Initiation and stabilisation by specialist
Unnecessary to maintain patient on specific manufacturer's products.


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Oxcarbazepine Trileptal®
Formulary

Oxcarbazepine 150mg Film-coated Tablets
Oxcarbazepine 300mg Film-coated Tablets
Oxcarbazepine 600mg Film-coated Tablets
Oxcarbazepine Oral Solution 60mg/ml

Restriction: Initiation and stabilisation by specialist
Maintain patient on specific manufacturer's products.


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Perampanel Fycompa®
Formulary

Perampanel 2mg tablets
Perampanel 4mg tablets
Perampanel 6mg tablets
Perampanel 8mg tablets
Perampanel 10mg tablets
Perampanel 12mg tablets

Restriction: Initiation and stabilisation by specialist
Unnecessary to maintain patient on specific manufacturer's products.

All strengths priced the same so optimise dose for cost effective prescribing.(Applicable in Primary care only)

Link  NICE CG137: The epilepsies: the diagnosis and management of the epilepsies in adults and children in primary and secondary care
 

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Phenobarbital
Formulary

Phenobarbital Tablets 15mg
Phenobarbital Tablets 30mg
Phenobarbital Tablets 60mg
Phenobarbital Elixir 15mg/5ml

Restriction: Initiation and stabilisation by specialist
Maintain patient on specific manufacturer's products.


Controlled Drug  Amber View adult BNF  View SPC online  View childrens BNF
Phenytoin
Formulary

Phenytoin Sodium Capsule 25mg 
Phenytoin Sodium Capsule 50mg  
Phenytoin Sodium Capsule 100mg
Phenytoin Sodium Capsule 300mg 
Phenytoin Sodium Chewable Tablets 50mg
Phenytoin Sodium Tablets 100mg
Phenytoin Oral Liquid 30mg/5ml

Restriction: Initiation and stabilisation by specialist
Maintain patient on specific manufacturer's products.

Additional Information June 2006:
Phenytoin 90mg in 15mL suspension may be considered approximately equivalent to capsules containing phenytoin sodium 100mg.

Phenytoin interacts significantly with NG feeds- please contact pharmacy for more information where necessary.


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Primidone
Formulary

Primidone Tablets 50mg 
Primidone Tablets 250mg

Restriction: Initiation and stabilisation by specialist
Maintain patient on specific manufacturer's products.


Amber View adult BNF  View SPC online  View childrens BNF
Retigabine
Formulary

Retigabine Tablet 50mg
Retigabine Tablet 100mg
Retigabine Tablet 200mg 
Retigabine Tablet 300mg 
Retigabine Tablet 400mg

Discontinued June 2017. See manufacturer's note

Restriction: In line with NICE Guidance only

Link  NICE TA232: Retigabine for the adjunctive treatment of adults with partial onset seizures in epilepsy with and without secondary generalisation
 

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Sodium Valproate
Formulary

Sodium Valproate Tablet 100mg 
Sodium Valproate Tablet 300mg M/R 
Sodium Valproate Tablet 500mg M/R 
Sodium Valproate Tablet E/C 200mg 
Sodium Valproate Tablet E/C 500mg 
Sodium Valproate Oral Solution 200mg/5ml S/F

Restriction: Initiation and stabilisation by specialist
Maintain patient on specific manufacturer's products.

 

Contraindicated in women of childbearing potential unless part of the Pregnancy Prevention Programme (MHRA, March 2018).

Women of Childbearing Potential: Educational Risk Minimisation Materials

Patient Card – to be given by pharmacists to all female patients who are dispensed valproate medicines to inform them of the risks

 


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Topiramate
Formulary

Topiramate Tablet 25mg 
Topiramate Tablet 50mg 
Topiramate Tablet 100mg 
Topiramate Tablet 200mg

Restriction: Initiation and stabilisation by specialist
Unnecessary to maintain patient on specific manufacturer's products.


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Vigabatrin Sabril®
Formulary

Vigabatrin Tablet 500mg 
Vigabatrin Powder Sachet 500mg S/F

Restriction: By specialist only
Unnecessary to maintain patient on specific manufacturer's products.


Red View adult BNF  View SPC online  View childrens BNF
Zonisamide Zonegran®
Formulary

Zonisamide 25mg capsules
Zonisamide 50mg capsules
Zonisamide 100mg capsules

Restriction: Initiation and stabilisation by specialist
Unnecessary to maintain patient on specific manufacturer's products.


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Brivaracetam Briviact®
Formulary

Brivaracetam Tablets 10mg
Brivaracetam Tablets 25mg
Brivaracetam Tablets 50mg
Brivaracetam Tablets 75mg
Brivaracetam Tablets 100mg
Brivaracetam Oral Solution 10mg/ml
Brivaracetam Solution for Injection 50mg/5ml vials

3rd line agent.

For adjunctive therapy in the treatment of partial onset seizures with or without secondary generalisation in adult, adolescent and paediatric patients from 4 years of age with severe refractory epilepsy warranting epilepsy specialist input who have

  1. Tried 3 or more antiepileptic medications, and
  2. Have used levetiracetam and has documented intolerance, and would not be suitable for other third line agents; and
  3. Is currently on a 3rd line agent which would be replaced by Brivaracetam; or
  4. Has tried 3 or more antiepileptic medications and has insufficient symptom control and requires rapid attainment of therapeutic levels.

Restriction: For initiation and stabilisation by a specialist 
Unnecessary to maintain patient on specific manufacturer's products.

After stabilisation, primary care may continue its prescribing on receipt of Specialist Clinic patient-specific letter which must include:

  • The previous antiepileptic medications tried
  • Intolerance to Levetiracetam
  • An improvement in side effects after switching from Levetiracetam to Brivaracetam

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