This information is relevant to people who live in the UK.
Epilepsy medicines are often available in different versions made by different companies. For some people, there’s a chance that switching between versions could affect their seizure control or side-effects.
Why are there different versions of my epilepsy medicine?
Many medicines, including most epilepsy medicines, are available in both branded and generic versions.
Branded medicines
In the first years that a new medicine becomes available, the company that developed it usually takes out a patent. This means that only they can sell it. This company gives it a brand name. So for the first few years that a new epilepsy medicine is available, the only version is the branded version.
Generic medicines
Once the original company’s patent runs out, other companies can start making their own versions of the medicine. These medicines are known as generic or non-proprietary medicines. There can be many different generic versions of the same epilepsy medicine. Most will use the name of the active ingredient, but occasionally a company will give their generic version its own brand name. These are known as branded generics.
Doctors are encouraged to prescribe generic medicines where appropriate, as generic medicines tend to be cheaper for the NHS. This is called generic prescribing. It means your pharmacist can give you any company’s version of your medicine.
An example
Using the epilepsy medicine levetiracetam as an example, the branded version is called Keppra. But there are also a number of generic versions with the name levetiracetam.
See a full list of epilepsy medicines, including their generic and brand names.
Are there any differences between different versions of my epilepsy medicine?
Whatever version of epilepsy medicine you have, the active ingredient should be the same. For example, every version of levetiracetam 250mg tablets should contain 250mg of levetiracetam. However, all medicines have other ingredients as well as the main one. These other ingredients can be different, depending on who makes the medicine. Different versions of a medicine will also look different and have different packaging.
Could switching between different versions of my medicine be a problem?
It’s possible that for some types of epilepsy medicine, small differences between versions could affect how the medicine is absorbed and how well it works. Many people with epilepsy have no problems when switching between different versions of their medicine. But for some people, switching between different versions of their medicine could cause them to have an increase in seizures, or have a breakthrough seizure after being seizure free. Some people might have different or more side-effects. The risk varies depending on which medicine you take.
What is the guidance about switching between versions of my medicine?
The Medicines and Healthcare products Regulatory Agency (MHRA) has published guidance about prescribing epilepsy medicines. The guidance puts epilepsy medicines into 3 categories, based on the risk that switching between versions could lead to seizures or side-effects. This is what the MHRA says about prescribing medicines in each category:
Epilepsy medicine | Advice |
Category 1
| If you take one of these medicines, your doctor should make sure you stay on the same version. |
Category 2
| For these medicines, your doctor should use their clinical judgement and consult you and/or your carer when deciding whether you need to stay on the same version. The doctor should consider things like how frequent your seizures are and your treatment history. If you are seizure free, they should consider what impact having a breakthrough seizure would have. They should also take into account the other factors explained in category 3. |
Category 3
| If you take one of these medicines, the MHRA says there’s usually no need to stay on a particular drug company’s version. This is because differences between versions should not cause any problems with seizures or side-effects. But your doctor should consider other factors when deciding if you should stay on the same version. They should consider if differences in product name, packaging, appearance, and taste could lead to dissatisfaction, anxiety, confusion, dosing errors, or not taking medicine. They should also consider difficulties for patients with autism, mental health problems, or learning disabilities. |
How can I get the same version of my epilepsy medicine?
If you and your doctor agree you should stay on the same version of your medicine, your doctor can write the brand name on your prescriptions. Or, if you want to stay on a particular manufacturer’s generic version, the doctor can write the generic name and the name of the manufacturer on your prescription. Your pharmacist should always try to give you the version your doctor has written on your prescription.
What if I can’t get the version of epilepsy medicine I usually take?
Sometimes your pharmacist might not be able to get your usual version of epilepsy medicine. There can be a number of reasons for this, including:
- The manufacturer has run out of stock, perhaps because of a manufacturing problem or an increase in demand
- The wholesalers that supply your pharmacy are out of stock
- The manufacturer or wholesaler allows a certain amount of stock for each pharmacy (called a quota), and your pharmacy has reached the limit of how much it can order
- The manufacturer has stopped making the medicine
If your pharmacist doesn’t have your usual version in stock, you can ask for your prescription back and take it to another pharmacy. But if your usual version isn’t available anywhere, you may have no choice but to take a different version. If you have any worries about taking a different version, your doctor should be able to give you advice. For most people, it is safer to take a different version of their medicine than to run out and stop taking medicine suddenly.
For the latest updates on epilepsy medicine shortages, visit our drugwatch page.
We are often asked if the UK’s exit from the EU (Brexit) will lead to shortages of epilepsy medicine. We are monitoring the progress of negotiations between the UK and EU and engaging with government on the issue of medicine supply. For the latest news visit our epilepsy and Brexit blog.
How can I report problems with my epilepsy medicines?
If you think you are getting side-effects from your epilepsy medicine, or they have caused your epilepsy to change, talk to your GP. They can report these issues to the MHRA. You can also report side-effects yourself by completing a Yellow Card. These are available from your GP, pharmacist or the Yellow Card scheme:
Tel: 0800 731 6789 (10.00am – 2.00pm Monday – Friday)
Website: yellowcard.mhra.gov.uk
If you would like to see where our information is from, download a copy of this information with references.
Epilepsy Action would like to thank thank Dr John Paul Leach, consultant neurologist at the Queen Elizabeth University Hospital, Glasgow, for his contribution to this information.
Dr John Paul Leach has declared no conflict of interest.
- Updated December 2020To be reviewed December 2023
Comments: read the 5 comments or add yours
Comments
I sometimes have issues with trying to stick to the same brand of my Medication which is Lamotrigine. My nurse suggests I must stick to the same brand that is in stock. It doesn't matter which one too much, but if there isn't enough of one that I must stick to, then what do I have to do? I am trying to find more information about this issue but unfortunately, I am having no luck.
As you can see from our website information lamotrigine is in Category 2 medicine. This means that your doctor should use their clinical judgement and consult you when deciding whether you need to stay on the same version.
I'm unsure from your message about what your nurse meant when they said that you must stick to the same brand that is in stock. And that it doesn't matter which one too much.
Because we are not medically trained we are not able to give you medical advice. It sounds like it might be worth getting in touch with your nurse to ask for some clarification?
If you and your doctor agree you should stay on the same version of your medicine, your doctor can write the brand name on your prescriptions. Or, if you want to stay on a particular manufacturer’s generic version, the doctor can write the generic name and the name of the manufacturer on your prescription. Your pharmacist should always try to give you the version your doctor has written on your prescription.
If your pharmacist doesn’t have your usual version in stock, you can ask for your prescription back and take it to another pharmacy. But if your usual version isn’t available anywhere, you may have no choice but to take a different version. For most people, it is safer to take a different version of their medicine than to run out and stop taking medicine suddenly.
I hope this information helps. But if we can be of any more help, please feel free to contact us again, either by email or the Epilepsy Action Helpline freephone 0808 800 5050. Our helpline is open Monday to Thursday 8.30am until 7.00pm, Friday 8.30am until 4.30pm and Saturday 10.00am until 4.00pm.
Regards
Tove
Helpline Team
I take Phenobatbital. 22 years ago my pharmacist insisted that a different brand would be exactly the same. Despite being aware that changing brands can cause breakthrough seizures he was adamant there was no difference. I had been seizure free for 8 years. Eventually I felt I had no option but to take the other brand but I pointed out how long I had been seizure free and asked that, if I had a seizure within the next 3 months that he would revert back to my normal brand. Exactly a month to the day of starting the new brand, I had a seizure.
This potentially has further repercussions with quality of life - loss of driving licence, job, home and even SUDEP after such good control.
I appreciate that, generally, for many medical conditions and certain anticonvulsants a change in brand is safe, though there may be minor differences in side effects.
However when it is proven that maintenance of a specific brand is a necessity - for it to be a lottery every month whether I can get the brand I need is no way to live my life. My doctor puts the brand required on my prescription. The guidelines have both reduced the amount I can have at any time and restricted when it can be re-ordered to a few days before. Yet it can take over 3 weeks to find a chemist who has a supply.
I am told by some pharmacies that it is no longer available. By others that there is a supply issue, the next, that they are unable to specify a brand on their system.
I am fully aware of the fact that pharmacies are only refunded the cheapest brand costs and therefore are penalised if my brand is not the cheapest.
The manufacturers inform me that there is no supply problem and it is down to the distributors like Alliance, AA Medical etc - as a profoundly deaf layperson I cannot contact these companies easily for their ‘reasons’. It would be more logical to use the official document ‘prescription’ directly with the manufacturers and avoid all the middle men quite frankly.
It seems it is all about negating responsibility and profit versus peoples quality of life and even risk of death - to live every day not knowing if the next time I order I will not be able to get the brand needed is both callous and cruel. To put the onus on the layperson to run around an average of 9 pharmacies each time. Instead of provision for pharmacies, where it is necessary for that persons seizure control, quality of life and even life itself, to be able to order the required brand without financial penalty and alleviating the severe stress caused to their customer every month.
This definitely needs resolving since my quality of life is negligible under such duress non stop from this situation
Regards
Diane
Hi,
I had a TIA followed by a stroke with a bleed in the brain when I was 19 years old. It left me paralysed down my left side and I had to learn to walk and talk again.
I am now 45 years old and switching from keppra to lamotrigine.
I've had numerous reactions from stomach cramps, shoulder pain, doube/blurred vision, dizziness, muscle stiffness, brain flips, unsteadiness and now, a really painful, swollen knee.
I guess my question is, are these symptoms from coming off the keppra, or going on to lamotrigine or both
(I have had more frequent seizures, ranging from, vacant seizures, myoclonus, to grand mals)
Any help with this situation would be really appreciated.
Many thanks