Advice for healthcare professionals
The categorisation of AEDs is intended to help healthcare professionals decide upon whether it is necessary to maintain continuity of supply of a specific formulation. Where this is deemed necessary, the product should be prescribed by brand name or by generic name with the inclusion of the manufacturer's name.
All drugs in category 1 should be prescribed in this manner. When agreement is reached between patient and prescriber over the need to maintain continuity of supply of a category 2 or 3 drug, this should be recorded in the patient's medical record and the prescription amended accordingly. It would seem prudent to begin a review process so that every patient taking an AED is assessed and the outcome recorded.
A Drug Safety Update issued in November 20176 provided prescribers with additional guidance on when continuity of supply should be maintained with class 2 or 3 drugs. This update advised prescribers to not only consider the classification of the drug but also the perception of the patients of differences of supply, for example differences in product appearance or presentation, and also the impact a change could have in patients with co-morbid autism, mental health issues or learning disability.
During the dispensing process pharmacists should be alert for instructions to dispense a specific manufacturer’s product and adhere to those instructions in all but exceptional circumstances. Where it is not possible to maintain continuity of supply close collaboration with patient and prescriber is necessary to minimise the risks associated with AED switching.
The information and advice given by CHM and reviewed in this module is only applicable to AEDs when being used to manage epilepsy and not for other indications such as neuropathic pain.
As always, suspected adverse drug reactions should be reported to MHRA via the Yellow Card scheme.
Advice to give patients
- Their doctor will discuss the patient's own particular needs as well as the nature of their particular AED before making a joint decision with them on whether to stick to the same manufacturer's product or not.
- The patient should write down the name and the manufacturer of each AED they take for their own personal record.
- If a pharmacist supplies a different manufacturer's product to the one they usually take, double-check with the pharmacist that it is OK to switch.
- If they have any concerns about their epilepsy and its treatment speak to a healthcare professional.