MHRA urges caution in switching epilepsy drugs
Clinical Switching between different manufacturers’ epilepsy drugs could cause patients to have seizures or suffer other side effects, Commission on Human Medicines has warned.
Switching between different manufacturers' epilepsy drugs could cause patients to have seizures or suffer other side effects, the MHRA has warned.
The medicines watchdog urged healthcare professionals to exercise caution when switching their patients between drugs, after a review by the Commission on Human Medicines found patient harm "could not be completely ruled out" in some cases.
The MHRA split anti-epileptic drugs into three categories, based on the risk of harm from switching, in advice released today (November 12).
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A review by the Commission on Human Medicines found patient harm when switching patients between epilepsy drugs "could not be completely ruled out" |
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Patients on the four medicines that fall into category one – phenytoin, primidone, phenobarbital and carbamazepine – should be maintained on a specific manufacturer's product, the MHRA said. |
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Clinicians should exercise caution when prescribing the drugs that fall into category two, which include valproate, rufinamide and clonazepam. The decision to switch patients on these drugs should be based on clinical judgement and consultation with the patient or carer, "taking into account factors such as seizure frequency and treatment history", the MHRA advised. It was "usually unnecessary" to stick to a particular manufacturer when prescribing the seven category three medicines such as gabapentin and lacosamide, the MHRA ruled. But it advised clinicians to be mindful of specific concerns such as patient anxiety and risk of confusion and dosing errors. Siu Ping Lam, the MHRA's acting director of licensing, said: "The categories of anti-epileptic drugs are designed to help healthcare professionals decide upon whether it is necessary to maintain continuity of supply of a particular manufacturers' product." "If patients have any concerns about, or problems with, their anti-epileptic medicine, they should speak to a healthcare professional such as a doctor, pharmacist or nurse." |
The three categoriesCategory one medicines: Phenytoin Carbamazepine Phenobarbital Primidone Category two medicines: Valproate Lamotrigine Perampanel Retigabine Rufinamide Clobazam Clonazepam Oxcarbazepine Eslicarbazepine Zonisamide Topiramate Category three medicines: Levetiracetam Lacosamide Tiagabine Gabapentin Pregabalin Ethosuximide Vigabatrin |
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