The Pharmaceutical Journal
Vol 275 No 7360 p435
8 October 2005

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Patients advised to alert their doctors if pharmacists switch their epilepsy drug

Patients with epilepsy should alert their doctors if pharmacists switch their medicine from a branded to a generic product or vice versa, according to the International Bureau for Epilepsy (IBE).

It carried out a survey of 435 neurologists and GPs from the UK, France, Germany, Spain and Canada to get their views on the issue. The survey included 154 doctors from the UK. Over half (55 per cent) were opposed to pharmacists making switches.

“ We are saying that patients with epilepsy should have consistency of supply,” said Pam Crawford, a consultant neurologist at York District Hospital and member of the IBE. “This could be a brand leader but also a generic.” She added that 1 to 2 per cent of patients might experience breakthrough seizures associated with a change in medication.

The survey follows research by the European General Medicines Association carried out in June showing that in some European countries pharmacists are swapping medication without telling patients or their neurologist or GP. It was funded by GlaxoSmithKline, manufacturer of lamotrigine (Lamictal), and comes as a number of generic antiepileptic drugs are due to be launched across Europe in the next few months.

Both the National Institute for Health and Clinical Excellence and the Scottish Intercollegiate Guidelines Network recommend that patients who are stable and seizure-free on a particular type of medicine — whether generic or branded — continue with that medication. The Royal Pharmaceutical Society, the National Prescribing Centre and the BNF all recommend that brands of modified release preparations should not be swapped.

Charles Tugwell, clinical pharmacist for neurology and neurosurgery at Barts and The London NHS Trust, said: “Pharmacists are aware of the potential differences between modified release preparations. There is much less potential of a problem with ordinary [epilepsy] tablets. With them we can change between brands but if someone comes into hospital on a modified release preparation we would be much more likely to maintain them on that even to the point where we would buy it in if necessary.”