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Birmingham, Sandwell, Solihull and environs APC Formulary
Maintained by Midlands and Lancashire Commissioning Support Unit
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 Formulary Chapter 4: Central nervous system - Full Chapter
04.08.01  Expand sub section  Control of epilepsy
 note 

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

04.08.01  Expand sub section  Partial seizures with or without secondary generalisation
04.08.01  Expand sub section  Generalised seizures
04.08.01  Expand sub section  Carbamazepine and Oxcarbazepine
04.08.01  Expand sub section  Ethosuximide to top
04.08.01  Expand sub section  Gabapentin and pregabalin
04.08.01  Expand sub section  Lacosamide
04.08.01  Expand sub section  Lamotrigine
04.08.01  Expand sub section  Levetiracetam
04.08.01  Expand sub section  Perampanel to top
04.08.01  Expand sub section  Phenobarbital and other barbiturates
04.08.01  Expand sub section  Phenytoin
04.08.01  Expand sub section  Retigabine
04.08.01  Expand sub section  Rufinamide
04.08.01  Expand sub section  Tiagabine to top
04.08.01  Expand sub section  Topiramate
04.08.01  Expand sub section  Valproate
Sodium Valproate
View adult BNF View SPC online View childrens BNF
Formulary
Amber
  • E/C tablets
  • M/R tablets
  • Crushable tablets
  • SF liquid
  • M/R granules see Episenta®
    MHRA Advice
    Care should be taken when switching between oral formulations. 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.

Contraindicated in women of childbearing potential unless part of the Pregnancy Prevention Programme.  See MHRA guidance

 
Link  Women of childbearing potential: Educational Risk Minimisation Materials
Link  Medicines related to valproate: risk of abnormal pregnancy outcomes
   
Sodium Valproate (Episenta®)
(M/R granules in capsules or sachets)
View adult BNF View SPC online View childrens BNF
Formulary
Amber
  • Paediatrician initiation.
  • For patients with epilepsy aged up to and including 16 years of age unable to swallow tablets and who require a modified release formulation in whom other formulations are more expensive or not appropriate.
    MHRA Advice
    Care should be taken when switching between oral formulations. 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.

Contraindicated in women of childbearing potential unless part of the Pregnancy Prevention Programme.  See MHRA guidance

 
Link  Medicines related to valproate: risk of abnormal pregnancy outcomes
Link  Women of childbearing potential: Educational Risk Minimisation Materials
   
04.08.01  Expand sub section  Vigabatrin
04.08.01  Expand sub section  Zonisamide
04.08.01  Expand sub section  Benzodiazepines to top
04.08.01  Expand sub section  Other Drugs
 ....
Key
note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Unlicensed
Track Changes
Display tracking information
click to search medicines.org.uk
Link to adult BNF
click to search medicines.org.uk
Link to children's BNF
click to search medicines.org.uk
Link to SPCs
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHSE
NHS England
Homecare
Homecare
CCG
CCG

Traffic Light Status Information

Status Description

Prescribing in children

The APC notes that the informed use of unlicensed medicines or of licensed medicines for unlicensed applications (‘off-label’ use) is often necessary in paediatric practice.

The APC advises GPs to consider specialist prescribing recommendations for Green and Amber medicines that are not subject to ESCAs or RICaDs in combination with the information provided in the BNFC which goes beyond that of marketing authorisations. The BNFC has been designed for rapid reference and the information presented has been carefully selected to aid decisions on prescribing.

  

Green

Medicines which are suitable for initiation and maintenance prescribing by primary and secondary care clinicians. These medicines should be initiated and prescribed within their licensed indications.  

Amber

Initiation and maintenance of prescribing by Specialists and transfer to Primary Care prescribing when appropriate, or initiation and maintenance of prescribing in Primary Care following recommendation from a Specialist.

Some amber medicines require agreement with the local (internal) medicines committee prior to initiation; others may require a framework to support safe transfer and maintenance of care such as a RICaD or ESCA. The Formulary will be annotated to reflect these requirements.   

Red

Medicines for initiation and maintenance prescribing by Specialists only  

Black

Non-formulary medicines- medicines not recommended for routine primary care prescribing.  

Grey

Positive NICE TA and /or awaiting local clarification on place in therapy ; Please contact your Medicines Optimisation team for more information.  

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