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Why do my drugs look different?

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This information is mainly about epilepsy treatment and anti-epileptic drugs in the UK. For information about anti-epileptic drugs in other countries, please contact your local epilepsy organisation.

 

Introduction

Sometimes when you pick up your prescription of anti-epileptic drugs, you may notice that they look different. For example there might be a different brand name on the box, or the tablets might be a different shape or colour.

What is continuity of anti-epileptic medication?

Continuity of anti-epileptic medication means getting the same make (brand) of your drugs every time you pick up your prescription.

Why do some drugs have two names?

Most drugs have a generic name and a brand name. The generic name is given to the active ingredient of the drug. The brand name is given to the drug by the drug company. For example, sodium valproate is the generic name and Epilim is the brand name. The drug company which first manufacturers the drug owns the ‘patent’ or exclusive rights to make it. After a number of years (usually 10-12), the patent runs out. Once the patent has run out, other companies can make their own versions of the drug.

A recent example is Lamictal, GlaxoSmithKline’s brand of the anti-epileptic drug lamotrigine, first licensed in the UK in 1991. Until May 2005, Lamictal was the only version of lamotrigine available, but now other generic versions of lamotrigine are on the market. Generic versions are often cheaper than the original brand and may be sold under the generic name or new brand names.

Lots of products have generic and brand names. For example, cola is the generic name and Coca Cola is the brand name.

Even though supermarket cola and Coca Cola are both essentially cola, there will be small differences between the two drinks. This is also true of generic and branded drugs. There are likely to be small differences in the way in which the two versions of the drug are made, for example: where they are made, how they are stored and the binding ingredients that hold them together.

For epilepsy, it is thought that these small differences between different versions of anti-epileptic drugs (AEDs) can be very important.

What is generic prescribing?

If your prescription just has the generic name, not the brand name of your AED, your drugs have been prescribed generically. This means that your GP has not instructed your pharmacist to give you a particular brand of AED, and they could give you any version, including generic makes.

What is a parallel import?

This is a version of a drug which has been made and imported from abroad.

Clues that this is the case might be that the writing on the packaging or Patient Information Leaflet may be in a foreign language, the packaging may be different or there may be a different brand name. For example, Tegretol Retard becomes Divitabs when purchased in France.

It is worth mentioning that some drugs are not made in the UK. For example, Topamax (topirimate), available on prescription in the UK, is made in several countries, but not here.

Why is it important to get the same AEDs every time?

For other medicines and medical conditions, people may be able to switch between different versions of drugs without any problems. However, for some people the small differences between different versions of anti-epileptic drugs could mean that changing brands could affect their seizure control and cause them to have more side-effects.

Some clinicians and patients have reported experiences where switching between different versions of AEDs has led to worse seizure control, for example more frequent or severe seizures, or breakthrough seizures in people who have been seizure free for some time.

Over the years, a number of people have contacted Epilepsy Action to report that, having been given a different version of their anti-epileptic drug (AED), their seizure control has been affected. For people who have had complete seizure control, having a seizure could have a huge impact on their lives, for example the loss of a driving licence. It has also been reported that switching between different versions of AEDs can lead to more or worse side effects.

In some cases where people have experienced worsened seizure control after being given a different version of their AED, it may be difficult to prove whether this has been caused by chemical differences between the different versions, or by the stress involved in being given a different version. Whatever the cause, Epilepsy Action believes that people with epilepsy should always receive the same version of their AEDs.

Getting the same version of your AED

To help make sure that you always get the same version of your AEDs, you can ask your doctor to write the brand of your AED on your prescription. If your doctor wants to know more about why this is important, there is some brief information on the NHS Direct website, which you may wish to show them. Your doctor can also contact us on our Epilepsy Helpline, freephone 0808 800 5050, helpline@epilepsy.org.uk.

It is important to note that Epilepsy Action is not saying that certain makes of anti-epileptic medication are better than others. Our concern is that people always receive the same make of their medication. If you take a generic type of AED it will not always be possible for your doctor to specify a brand name on your prescription. In this case, you could ask your doctor if it would be possible for them to write on the generic name and the name of the drug manufacturer.

If your doctor writes the brand of your anti-epileptic drugs on the prescription, the pharmacist must, by law, give you that specific brand. If they don't, they would be going against the instructions of the doctor and this could be seen as breaking the rules set out by the Medicines Act of 1968.

It may not be practical to make sure you get the same version of your AEDs every time, for example if your drugs are not manufactured in the UK. If you have concerns about this you should discuss them with your doctor. If you do have to change to a different version of your AED, keep a chart or seizure diary so you can record any changes to seizure control or side effects.

You can also report any concerns about your medication to the Medicines and Healthcare products Regulatory Agency (MHRA), using the Yellow Card system. This is a way in which you or your doctor can report any problems with your medication, for example side effects. A Yellow Card report form is available online. It is also possible to request a paper version. Eventually, it is expected that forms will be available from all doctor surgeries across the UK.

Medicines and Healthcare products Regulatory Agency (MHRA): 020 7084 2000;

 

The future

At the moment there is strong evidence based on the experiences of patients and doctors to support the importance of getting the same make of anti-epileptic medication every time. Epilepsy Action is actively lobbying for more research to prove why continuity of anti-epileptic medication is so important for people with epilepsy. We have already done a survey of our members to find out how many of them have experienced problems with continuity of their anti-epileptic medication.

Although clinical guidelines from the National Institute for Health and Clinical Excellence (NICE) and the Scottish Intercollegiate Guidelines Network (SIGN) clearly recommend maintaining continuity of anti-epileptic medication, there are currently no regulations to make sure that this happens.

Until further research has been carried out into continuity of anti-epileptic medication, Epilepsy Action believes that as a precaution, people with epilepsy should always receive the same make of their AEDs. Not all doctors and pharmacists agree on this issue but Epilepsy Action's advice is that if your epilepsy is well controlled with your current AED, try and always obtain exactly the same make of your medication from your pharmacist.

Useful links for more information

 

 

10 April 2007

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