Epilepsy (adults)

This guidance is intended for use by clinicians when using anti-seizure medication (ASM), also called antiepileptic drugs (AEDs), to manage epilepsy in adult patients in NHS South West London (SWL) and should be read in conjunction with NICE guidance NG217: Epilepsies in children, young people and adults which covers the diagnosis and management of epilepsy.

Recommendations

The SWL Joint Medicines Formulary lists the ASM that can be prescribed across South West London.

  • For ASM assigned Amber 1, to support safe prescribing in primary care:
    • The specialist is responsible for discussing treatment with the patient, including dose titration, side effects and taking ASM in pregnancy.
    • The specialist must provide the following minimum data set to the GP:
      • Patient demographics (Name, DOB, NHS number, address)
      • Epilepsy diagnosis
      • Current individualised anti-epileptic treatment strategy including:
        • Newly prescribed anti-seizure medication (ASM):
        • Medication to continue.
        • Any medication to be tapered and stopped (outline how to do this).
        • Management of seizures – Individualised emergency management plan.
        • Side effects: Detail if there are significant side effects for specific ASM and provide link to Medicines A to Z – NHS.
        • Monitoring: Details of any specific monitoring by GP (this is not usually required).
        • Documented discussion between patient and specialist about taking anti-seizure medications during pregnancy and contraceptive advice provided. For valproate and topiramate, ensure conditions of the Pregnancy Prevention Programme are met and relevant Risk Acknowledgement Form / Risk Awareness Form sent to GP.
        • Contact details for Consultant or Specialist Nurse.
        • Details of follow-up with specialist.
    • The GP is responsible for titrating the dose of the ASM and monitoring (if required) as specified by the specialist.

Advice on switching between different manufacturers’ products

  • When deciding whether it is necessary to maintain continuity of supply of a specific manufacturer’s product for an anti-seizure medication, the three risk-based categories of anti-seizure medication and patient-related factors should be taken into consideration.
  • Switching between different manufacturers’ anti-seizure medication requires individual assessments and careful consideration about whether it will be suitable.
  • Refer to MHRA Antiepileptic drugs: updated advice on switching between different manufacturers’ products and SPS advice.

Anti-seizure medication and pregnancy

Valproate

  • Refer to MHRA Valproate: updated safety and educational materials  for regulatory requirements for the use of valproate and supporting materials.
  • Refer to SWL Safe Use of Valproate Policy which provides advice and guidance for healthcare professionals to ensure the safe prescribing and dispensing of valproate for all patients across SWL.
  • The SWL Joint Formulary RAG ratings for valproate for epilepsy are as follows:
    • Amber 2:
      • Female patients over 55 years of age – new and existing (outside scope of MHRA alert)
      • Male patients prescribed valproate (new and existing)
      • Female children (pre-menarche) (outside scope of MHRA alert)
      • Female patients of childbearing potential who meet the requirements of the Pregnancy Prevention programme (PPP)
    • Amber 3:
      • Female patients of childbearing potential who do not meet the requirements of the PPP (unlicensed use): Refer to the valproate shared care agreement for further information.
    • Red (Hospital only)
      • Patients with only one specialist signature (unlicensed use)

Topiramate

  • Regulatory measures have been introduced because there is evidence that the use of topiramate during pregnancy is associated with significant harm to the unborn child.
  • The use of topiramate is now contraindicated:
    • In women of childbearing potential unless the conditions of the Pregnancy Prevention Programme (PPP) are fulfilled.
    • In pregnancy for epilepsy unless there is no other suitable treatment.
  • Refer to MHRA Topiramate safety measures for further information and support material.
  • Existing patients: Refer to topiramate flow diagram which outlines how to manage existing female patients of childbearing potential prescribed topiramate in primary care.
  • The SWL Joint Formulary RAG ratings for topiramate for epilepsy are as follows:
    • Amber 2:
      • Women of childbearing potential, conditions of PPP met
      • All other cohorts (i.e. Patients outside scope of MHRA alert)
    • Red (Hospital only):
      • Women of childbearing potential, conditions of PPP not met.

References/resources

V1.0 Approved by Integrated Medicines Optimisation Committee (IMOC) October 2025