netFormulary NHS
Birmingham, Sandwell, Solihull and environs APC Formulary
Maintained by Midlands and Lancashire Commissioning Support Unit
 Search
 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
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
BrivaracetamBlack Triangle (Briviact®)
(oral formulations)
View adult BNF View SPC online View childrens BNF
Formulary
Amber
  • Initiation by Tertiary Epilepsy Specialist only.
  • For 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 severe refractory epilepsy warranting tertiary specialist input for patients who have tried three or more AEDs. The patient has used levetiracetam and has documentation of intolerance and patient is using a third line agent (perampanel, zonisamide, lacosamide, eslicarbazepine) which would be replaced by brivaracetam.
  • Supported by an ESCA
 
   
Brivaracetam (Briviact ®)
(injection)
View adult BNF View SPC online View childrens BNF
Formulary
Red
 
   
Stiripentol (Diacomit®)
(250mg capsules, sachets, 500mg capsules)
View adult BNF View SPC online View childrens BNF
Formulary
Red
Severe myoclonic epilepsy in infancy (Dravet syndrome)
APC supports use in Adults: for continuation of therapy started in childhood. (Note Off Label use in adults) 
   
 ....
 Non Formulary Items
Acetazolamide

View adult BNF View SPC online View childrens BNF
Non Formulary
 
  
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.  

netFormulary