For all documents and guidance relating to Epilepsy in adults and children on the SY MO website click here
For all documents and guidance relating to Sodium Valproate Guidance in Primary Care on SY MO website Click Here
Prescribing responsibility for this group of AMBER drugs may be handed over to Primary Care Prescribers once patients are stabilised at which point they will become Amber-G status
Message from the CEU: Medication safety updates on Topiramate and DMPA | FSRH
For Guidance for the use of Subcutaneous Levetiracetam in Palliative and End of Life Care (Adults) on the SY MO website Click Here Adopted from Harrogate and York area with permission( please do not use the telephone contacts on the form - Contact DBTHFT )
Diazepam Injection (emulsion)
Short term relief (two to four weeks only) of severe anxiety
Adjunctive therapy at the start of antidepressant treatment to prevent the initial worsening of symptoms
Antiepileptic
*Hospital Use only*
Rationale: 1,2
Section 4.1 Hypnotics and anxiolytics
Section 4.8 Antiepileptics
Hospital use only
Anxiolytic
Short term relief of severe anxiety/Epilepsy
*Hospital Use only*
Section 4.1 : Formulary
Section 4.8 : Formulary
Anti-epileptic
*Hospital Use Only*
Hospital use only
Valproate (Belvo, Convulex, Depakote, Dyzantil, Epilim, Epilim Chrono or Chronosphere, Episenta, Epival, and Syonell▼): new safety and educational materials to support regulatory measures in men and women under 55 years of age Click here
NHS South Yorkshire ICB Valproate Guidance in Primary Care click here
Anticonvulsant
Brand: Briviact
This anti-epileptic agent is available for use only on the advice of an Epilepsy Specialist or Consultant Neurologist
| Pack | Price |
|---|---|
| 56 tablet | £129.64 |
| Pack | Price |
|---|---|
| 14 tablet | £34.64 |
| Pack | Price |
|---|---|
| 56 tablet | £129.64 |
| Pack | Price |
|---|---|
| 56 tablet | £129.64 |
| Pack | Price |
|---|---|
| 300 ml | £115.83 |
| Pack | Price |
|---|---|
| 56 tablet | £129.64 |
Epilepsy
| Pack | Price |
|---|---|
| 84 tablet | £2.07 |
| Pack | Price |
|---|---|
| 300 ml | £12.93 |
| Pack | Price |
|---|---|
| 56 tablet | £5.20 |
| Pack | Price |
|---|---|
| 84 tablet | £3.83 |
*Expensive item *
| Pack | Price |
|---|---|
| 5 suppository | £177.22 |
| Pack | Price |
|---|---|
| 56 tablet | £10.24 |
| Pack | Price |
|---|---|
| 56 tablet | £5.02 |
Epilepsy, focal-onset seizures - Red listed for use in children
Licensed Indications: Adjunctive treatment of focal seizures with or without secondary generalisation. It should only be used as an add-on treatment, after at least 1 other add-on treatment has not controlled seizures and treatment is started in a tertiary epilepsy service.
Epilepsy
This anti-epileptic agent is available for use only on the advice of an Epilepsy Specialist or Consultant Neurologist
| Pack | Price |
|---|---|
| 30 tablet | £2.50 |
| Pack | Price |
|---|---|
| 150 ml | £29.35 |
Anticonvulsant
This anti-epileptic agent is available for use only on the advice of an Epilepsy Specialist or Consultant Neurologist
| Pack | Price |
|---|---|
| 100 tablet | £5.69 |
| Pack | Price |
|---|---|
| 150 ml | £73.86 |
| Pack | Price |
|---|---|
| 100 tablet | £4.23 |
| Pack | Price |
|---|---|
| 150 ml | £47.45 |
| Pack | Price |
|---|---|
| 60 tablet | £68.00 |
| Pack | Price |
|---|---|
| 30 tablet | £48.18 |
Epilepsy
This anti-epileptic agent is available for use only on the advice of an Epilepsy Specialist or Consultant Neurologist
| Pack | Price |
|---|---|
| 56 capsule | £50.72 |
| Pack | Price |
|---|---|
| 200 ml | £131.19 |
| Pack | Price |
|---|---|
| 200 ml | £91.43 |
| Pack | Price |
|---|---|
| 56 capsule | £88.50 |
Anticonvulsant
| Pack | Price |
|---|---|
| 100 capsule | £1.24 |
| Pack | Price |
|---|---|
| 100 capsule | £1.82 |
| Pack | Price |
|---|---|
| 100 capsule | £2.32 |
| Pack | Price |
|---|---|
| 100 tablet | £6.98 |
| Pack | Price |
|---|---|
| 100 tablet | £14.06 |
Epilepsy
Restricted prescribing
Lacosamide is excreted in human breast milk, and a risk to the newborns/infants cannot be excluded. It is recommended that breast-feeding should be discontinued during treatment. (EMC June 2022)
| Pack | Price |
|---|---|
| 56 tablet | £2.98 |
| Pack | Price |
|---|---|
| 56 tablet | £18.40 |
| Pack | Price |
|---|---|
| 56 tablet | £4.81 |
| Pack | Price |
|---|---|
| 56 tablet |
Epilepsy
SPC states both Lamictal tablets and Lamictal chewable/ dispersible tablets contain less than 1mmol sodium (23mg) per tablet, that is to say essentially 'sodium free'
Drug Safety Update December 2012
| Pack | Price |
|---|---|
| 56 tablet | £13.02 |
| Pack | Price |
|---|---|
| 56 tablet | £1.70 |
| Pack | Price |
|---|---|
| 56 tablet | £17.81 |
| Pack | Price |
|---|---|
| 56 tablet | £1.10 |
| Pack | Price |
|---|---|
| 56 tablet |
| Pack | Price |
|---|---|
| 300 ml |
| Pack | Price |
|---|---|
| 60 tablet | £4.18 |
| Pack | Price |
|---|---|
| 60 tablet | £1.52 |
| Pack | Price |
|---|---|
| 60 tablet | £4.03 |
| Pack | Price |
|---|---|
| 60 tablet | £3.12 |
Epilepsy
Brand : Trileptal
This anti-epileptic agent is available for use only on the advice of an Epilepsy Specialist or Consultant Neurologist
Drug Safety Update
Antiepileptic drugs: updated advice on switching between different manufacturers’ products Nov 2017
The risk of serious skin-related adverse drug reactions, including Stevens-Johnson syndrome, occurring with carbamazepine may be increased in the presence of the HLA-A*3101 allele in patients of European descent or Japanese origin. However, there are currently insufficient data to support screening for this allele before starting carbamazepine treatment. Patients of European descent or Japanese origin who are known to be positive for this allele should only receive carbamazepine, oxcarbazepine or eslicarbazepine after careful consideration of the benefits and risks.
| Pack | Price |
|---|---|
| 50 tablet | £20.68 |
| Pack | Price |
|---|---|
| 50 tablet | £11.96 |
| Pack | Price |
|---|---|
| 50 tablet | £53.41 |
| Pack | Price |
|---|---|
| 250 ml | £48.96 |
Epilepsy, Anticonvulsant for use in adults & children with guidance from Secondary Care
Brand : Fycompa
| Pack | Price |
|---|---|
| 28 tablet | £140.00 |
| Pack | Price |
|---|---|
| 28 tablet | £140.00 |
| Pack | Price |
|---|---|
| 28 tablet | £140.00 |
| 7 tablet | £35.00 |
| Pack | Price |
|---|---|
| 28 tablet | £140.00 |
| Pack | Price |
|---|---|
| 340 ml | £127.50 |
| Pack | Price |
|---|---|
| 28 tablet | £140.00 |
| Pack | Price |
|---|---|
| 28 tablet | £140.00 |
Epilepsy
Also known as phenobarbitone
Epilepsy
| Pack | Price |
|---|---|
| 500 ml | £4.27 |
| Pack | Price |
|---|---|
| 84 capsule | £9.14 |
| Pack | Price |
|---|---|
| 28 capsule | £14.90 |
| Pack | Price |
|---|---|
| 28 capsule | £7.07 |
Epilepsy
Updated guidance MHRA February '21: click here
Updated SPC March'22
Update section 4.4 has been updated to highlight that pregabalin should not be used during pregnancy unless the benefit to the mother clearly outweighs the potential risk to the foetus.
*pregabalin has been associated with reports of respiratory depression, in some cases without concomitant opioid treatment
*consider whether adjustments in dose or dosing regimen are necessary for patients at higher risk of respiratory depression, this includes people: *with compromised respiratory function, respiratory or neurological disease, or renal impairment
*taking other CNS depressants (including opioid-containing medicines)
*aged older than 65 years
SPC update - sections 4.4 and 4.5 advise caution when used with opioids due to risk of CNS depression - this increased risk was observed at low doses of pregabalin (≤ 300 mg) and there was a trend for a greater risk at high doses of pregabalin.
| Pack | Price |
|---|---|
| 84 capsule | £1.55 |
| Pack | Price |
|---|---|
| 56 capsule | £1.72 |
| Pack | Price |
|---|---|
| 84 capsule | £2.65 |
| Pack | Price |
|---|---|
| 473 ml | £57.18 |
| Pack | Price |
|---|---|
| 56 capsule | £1.75 |
| Pack | Price |
|---|---|
| 56 capsule | £1.07 |
| Pack | Price |
|---|---|
| 56 capsule | £2.09 |
| Pack | Price |
|---|---|
| 84 capsule | £2.21 |
| Pack | Price |
|---|---|
| 56 capsule | £1.07 |
Epilepsy
| Pack | Price |
|---|---|
| 100 tablet | £57.67 |
| Pack | Price |
|---|---|
| 100 tablet | £118.71 |
| Pack | Price |
|---|---|
| 100 tablet |
Anticonvulsant - Lennox-Gastaut syndrome
Brand: Inovelon
NICE CG137
| Pack | Price |
|---|---|
| 10 tablet | £5.15 |
| Pack | Price |
|---|---|
| 60 tablet | £61.77 |
| Pack | Price |
|---|---|
| 60 tablet | £102.96 |
| Pack | Price |
|---|---|
| 460 ml | £94.71 |
Epilepsy
NHS South Yorkshire ICB Valproate Guidance in Primary Care click here
Valproate (Belvo, Convulex, Depakote, Dyzantil, Epilim, Epilim Chrono or Chronosphere, Episenta, Epival, and Syonell▼): new safety and educational materials to support regulatory measures in men and women under 55 years of age Click here
Update on MHRA review into safe use of valproate Click here
| Pack | Price |
|---|---|
| 30 tablet | £1.68 |
| Pack | Price |
|---|---|
| 100 tablet | |
| 30 tablet | £2.54 |
| Pack | Price |
|---|---|
| 30 tablet | £3.50 |
| Pack | Price |
|---|---|
| 300 ml | £9.33 |
| Pack | Price |
|---|---|
| 300 ml | £15.40 |
| Pack | Price |
|---|---|
| 100 capsule |
| Pack | Price |
|---|---|
| 30 tablet | £5.24 |
| Pack | Price |
|---|---|
| 100 tablet | |
| 30 tablet | £5.38 |
| Pack | Price |
|---|---|
| 30 tablet | £8.73 |
Epilepsy
Brand : Topamax
NICE CG137 Epilepsies: diagnosis and management
Topiramate (Topamax): DSU July 2022
Beginning of safety review triggered by a study reporting an increased risk of neurodevelopmental disabilities in children with prenatal exposure following an observational study reporting an increased risk of neurodevelopmental disabilities in children whose mothers took topiramate during pregnancy.
Topiramate is already known to be associated with an increased risk of congenital malformations
and effects on foetal growth if used during pregnancy.
Actions
Continue to counsel patients who can become pregnant on the known and emerging risks of topiramate for an unborn baby and on the need to use effective contraception throughout use.
| Pack | Price |
|---|---|
| 60 tablet | £1.94 |
| Pack | Price |
|---|---|
| 60 capsule | £14.79 |
| Pack | Price |
|---|---|
| 60 tablet | £6.79 |
| Pack | Price |
|---|---|
| 60 capsule | £36.45 |
| Pack | Price |
|---|---|
| 60 tablet | £1.76 |
| Pack | Price |
|---|---|
| 60 capsule | £22.18 |
| Pack | Price |
|---|---|
| 60 tablet | £1.34 |
| Pack | Price |
|---|---|
| 1 ml |
| Pack | Price |
|---|---|
| 50 sachet | £24.60 |
| Pack | Price |
|---|---|
| 56 capsule | £7.65 |
| Pack | Price |
|---|---|
| 14 capsule | £5.81 |
| Pack | Price |
|---|---|
| 56 capsule | £6.38 |
Subcutaneous Levetiracetam in Palliative and End of Life Care (Adults)
Use of off-label subcutaneous levetiracetam offers the possibility of maintaining seizure control when the oral route is lost without increasing the level of sedation. The use of medicinal products off-label is widespread. Surveys say that up to one quarter of all prescriptions in palliative care come into this category. This includes the use of two or more medications in a syringe driver. The British Pain Society and Association for Palliative Medicine have produced recommendations for
this practice. It is recommended to initiate SC levetiracetam only following advice from the Palliative Care Team or Hospice.
For guidance and all information relating to dose conversion from oral medication see Guidance Document adopted from Harrogate and York area with permission and with Doncaster LMC support for the use of this documentation: Subcutaneous Levetiracetam in Palliative and End of Life Care (Adults) Click Here
Please do not use the telephone contacts on the guidance document - Contact DBTHFT below:-
Specialist advice is available within the hours of 08.30-16.30 from the hospice (Palliative triage is 03000 214666) and/or Consultants in Palliative Medicine via DRI switchboard (queries from GPs, doctors or SPC nurses only required).
Anticonvulsant
Brand: Gabitril
NICE CG137
| Pack | Price |
|---|---|
| 100 tablet | £104.09 |
| Pack | Price |
|---|---|
| 100 tablet | £156.13 |
| Pack | Price |
|---|---|
| 100 tablet | £52.04 |
Epilepsy, focal-onset seizures - Amber for use in Adults
Rationale 7
| Pack | Price |
|---|---|
| 14 tablet | £87.36 |
| 28 tablet | £136.50 |
| Pack | Price |
|---|---|
| 14 tablet |
| Pack | Price |
|---|---|
| 14 tablet | £89.18 |
| 28 tablet | £182.00 |
| Pack | Price |
|---|---|
| 14 tablet | £91.00 |
| 28 tablet | £182.00 |
| Pack | Price |
|---|---|
| 14 tablet |
| Pack | Price |
|---|---|
| 14 tablet | £85.54 |
| 28 tablet | £91.00 |
Epilepsy, focal-onset seizures - Amber for use in Adults
Rationale 7
| Pack | Price |
|---|---|
| 20 tablet | |
| 60 tablet | £68.00 |
| Pack | Price |
|---|---|
| 30 tablet | £48.18 |