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Getting the same version of your epilepsy medicine every time

This information is relevant to people who live in the UK.

Epilepsy Action believes that you should get the same version of your epilepsy medicine, whenever possible, every time you pick up a prescription. Having the same version is known as consistency of supply.

Generic and brand names

Nearly all medicines have a generic name and a brand name. The generic name is the name of the main ingredient. The brand name is given by the company that makes the medicine.

In the first years that a medicine becomes available for patients, it is under licence. This means that only the company that researched and developed it can sell it. This company gives it a brand name.

Once the licence runs out, any drug company can make the medicine. These medicines are called by the generic name and are known as non-proprietary medicines. They may be cheaper than branded ones. Some companies who make the medicine once the original licence runs out, give it their own brand name. These are known as branded generics.

For example, with carbamazepine:

First version: The first and original version of carbamazepine has the brand name Tegretol®.

Later version: A later version made by another company has the brand name Carbagen®. This is a branded generic.

Generic versions: There are also several generic or non-proprietary versions. These all have the generic name carbamazepine and no brand name.

Whatever version of epilepsy medicine you have, the active ingredient should be identical. So, every version of carbamazepine 100mg tablets should contain 100mg of carbamazepine. However, all medicines have other ingredients as well as the main one. These other ingredients can be different, depending on who makes the medicine. For some people, this difference could affect how well the medicine works. It could also mean they experience more or different side-effects.

Prescribing by brand

If a doctor writes a brand name on your prescription, the pharmacist must give you that specific brand.

Generic prescribing

If a doctor writes the generic name of your medicine on your prescription, a pharmacist can give you that medicine from any drug company. This is called generic prescribing. There is increasing pressure on the NHS to reduce its costs in many areas. One area is prescribing costs. Because generic medicines can be cheaper than branded versions, doctors and other prescribers may want to switch some people onto those cheaper versions.

Possible issues with generic prescribing

Some people say they have no problem with taking different versions of their epilepsy medicine. However, some people who have switched to a different version of their epilepsy medicine have told us that they have had seizures after being seizure-free for some time. And some people have had more seizures and/or side-effects that they haven’t had before.

What if I can’t get the version of epilepsy medicine I usually have?

Sometimes there can be a shortage of supplies or a company may stop making a medicine. Unfortunately, where this is the case, there may be no choice but to take a different version. The health professional who usually prescribes your epilepsy medicine should be able to advise you what to do in this instance.

Advice for people who prescribe epilepsy medicine

The Medicines and Healthcare products Regulatory Agency (MHRA) is an agency of the Department of Health. In 2017 they updated their guidance on prescribing epilepsy medicines. This followed a review by the Commission on Human Medicines (CHM) which looked at the evidence on patients switching between different manufacturers’ products of particular epilepsy medicines.

CHM advise that epilepsy medicines can be classified into three categories. This classification aims to help prescribers and patients decide whether it is necessary to maintain consistency of supply of a specific company’s product. It is not official policy, but guidance only.  

The MHRA’s guidelines about prescribing epilepsy medicines

Epilepsy medicine

Advice

Category 1

  • Carbamazepine
  • Phenobarbital
  • Phenytoin
  • Primidone

 

It has been shown that the differences between different drug companies’ products could affect seizure control and/or side-effects. Prescribers should ensure a specific drug company’s product is always prescribed.

Category 2

  • Clobazam
  • Clonazepam
  • Eslicarbazepine
  • Lamotrigine
  • Oxcarbazepine
  • Perampanel
  • Retigabine
  • Rufinamide
  • Topiramate
  • Valproate
  • Zonisamide

Whether to always have a specific drug company’s product should be based on what is right for the individual. Prescribers should talk this through with their patient and/or carer. They should look at things like seizure frequency and treatment history. They should also take into account how their patient and/or carer feels about being prescribed different versions of their epilepsy medicine.

Category 3

  • Brivaracetam
  • Ethosuximide
  • Gabapentin
  • Lacosamide
  • Levetiracetam
  • Pregabalin
  • Tiagabine
  • Vigabatrin

The likelihood of there being any differences that could affect seizure control and/or side-effects between different manufacturers' products is considered to be extremely low. However, prescribers should look at each patient individually, taking into account how they and/or their carers feel about being prescribed different versions of their epilepsy medicine. 

How to get the same version of your epilepsy medicine

The most reliable way to get the same version is to ask your doctor to 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 you take an epilepsy medicine that is in category1, your prescriber should ensure you always have the same version of your medicine. If you take an epilepsy medicine in categories 2 or 3, your prescriber might want to give you a generic prescription. However, the current guidelines say that they should also take into account how you feel about having a different version.

Reporting problems with 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 this information with references, visit the Advice and Information references section of our website. If you are unable to access the internet, please contact our Epilepsy Action Helpline freephone on 0808 800 5050. 

Code: 
F051.09

Epilepsy Action would like to thank Dr Joh Paul Leach, consultant neruologist, Southern General Hospital, Glasgow for his contribution.

Dr John Paul Leach has declared no conflict of interest.

This information has been produced under the terms of The Information Standard.

  • Updated November 2017
    To be reviewed November 2020

Comments: read the 16 comments or add yours

Comments

My adult son has epilepsy after sustaining head injuries in an accident. He is on Epilem and Keppra. After being given the generic Levetiracetam manufactured by Lupin, he has had several severel break through seizures. After reading the comments on this page I am absolutely shocked to see that the old medical adage "first do no harm" is being completely ignored. People are being put in serious risk of harm because the MHRA has decided to cut costs without, in my opinion, doing intensive research. There is no such thing as a text book case. I have filled in and submitted a yellow card to the MHRA and I hope the epilepsy society will continue to lobby them to look more closely at their guidelines.

Submitted by Carole Withey on

My boyfriend has moved recently to a new city and therefore a new doctors surgery.

He is currently taking Lamotrigine and due to headaches with other brands, was placed consistently on Teva at his old surgery.

Since moving in August he has had lots of troubles getting his repeated prescription and has been given at least 3 different brands of lamotrigine.

In the last month he has had 2 instances when he has felt close to seizing, one resulting in being sent home from work. We suspect this change is due to the lack of consistent medication and so he booked to see his new doctor.

Despite explaining the situation to the doctor and admitting it is causing anxiety, the doctor refused to prescribe him the Teva tablets, claiming "you can go and have an argument with the pharmacy if you want".

My boyfriend is now resigned to the constant change of tablets despite the issues this is presenting.

I'm just at a loss, I feel so helpless.

Submitted by Natalie on

Hi Natalie

Thank you for your post.

It is a difficult situation. It may be best to do as the doctor suggested and see if a local chemist will arrange for your boyfriend to always get TEVA.  Most chemist will try to help their customers.

You could also download the information from this webpage for your boyfriend to show the chemist.

If we can be of any more help, please feel free to contact us directly. You can either email helpline@epilepsy.org.uk or phone the Epilepsy Action Helpline freephone 0808 800 5050. Our helpline is open Monday to Friday, 8.30am until 5.30pm.

Regards

Diane, Epilepsy Action Helpline Team

Submitted by Diane@Epilepsy ... on

Hi. I came across this very good article whilst trying to research exactly the same issue for my bp/migraine medication. Candestartin. I've been given Spanish tablets which are just not effective. I've returned to my old initial symptoms that I hadn't had on the Teva. I spoke to the pharmacist this morning who wasn't that helpful. I am looking to change my pharmacy. Thanks for the information.
Sue

Submitted by Sue Mitchell on

There is a problem, currently, with the supply of levetiracetam. I have been unable to find a pharmacy which can supply it, but they will only give Keppra if it is stated on the prescription (which my mum's GP is refusing to do, due to its cost). However, I have just found that my local Boots only supplies Keppra (not a generic version), and that Lloyd's will supply Keppra if they cannot get hold of the cheaper generic version. This may be of help to anybody who needs a particular brand version of their epilepsy drugs, as it is possible that these bigger companies might also provide the branded versions of other medications.

Submitted by Maria on

I take a combination of Lamotrigine and Sodium Valproate in the forms of Lamictal and Epilim Chromo. Fortunately this combination of medicines works for me and has done for over twenty years.
Unfortunately, the last time I had my prescription dispensed at Morrisons I received the generic form of Lamotrigine rather than the branded Lamictal. I had to argue with the pharmacist to allow me to have the Lamictal brand which I received eventually. Yesterday I visited my doctor to establish a way to ensure this doesn't happen again and she has told me that she can only prescribe me Lamotrigine and has no control over the brand of lamotrigine the pharmacist prescribes and explained it's at the discretion of the pharmacist and profitability.

How can I find out which pharmacies are still prescribing Lamictal please? I haven't had a seizure for over 20 years and cannot afford to risk having another one as I live alone and depend on being able to drive in order to work.

Many thanks, Emma

Submitted by Emma on

Dear Emma

Thank you for your comment. Yes, it can be difficult getting exactly the same brand of lamotrigine all the time. The only sure way of doing this would be to get your GP to prescribe by brand. Although they say they can’t do that, the MHRA gives the following guidance: 

Category 2 – Valproate, lamotrigine, perampanel, retigabine, rufinamide, clobazam, clonazepam, oxcarbazepine, eslicarbazepine, zonisamide, topiramate

For these drugs the need for continued supply of a particular manufacturer’s product should be based on clinical judgement and consultation with patient and/or carer taking into account factors such as seizure frequency and treatment history.

If your GP prescribes Lamictal, that is actually the branded version, and no pharmacist can change that. However, if she prescribes by the generic name, lamotrigine, the pharmacist can dispense any version of lamotrigine – and there are several different ones.

 You might like to show your GP our information about getting the same drugs every time, as well as the MHRA guidance above.

I hope this helps. If we can be of any more help, please feel free to contact us again, either by email or the Epilepsy Helpline freephone 0808 800 5050. We are open Monday to Friday 8.30am until 5.30pm.

Regards 

Kathy 

Epilepsy Action Helpline Team

Submitted by rich on

I had never thought about this but now I am going through something which could be due to this.
I seemed to have developed neuropathy and side effect of atixia due to phenytoin. I have managed to get Lamictal but have all sorts for phenytoin. It may have contributed to me having toxic levels in my blood.
Please everyone make sure you get specific blood tests done.
I was at A&E and they sent me home saying my blood tests were clear. I was unhappy so asked the doctor and was told it had been done at A&E. I was unhappy and asked for blood test
I gave blood at about 3pm and at 5:30am next morning paramedics had come to take me to hospital as they said I had toxic levels of phenytoin
Because we stay seizure free it is possible we don't keep up to date with side effects that can creep in

Submitted by Harvinder on

My husband has been taking the teva brand of lamotrigine for the last 4 years, last week this was substitute with the Accord brand of lamotrigine he has been so poorly just two days after taking the Accord
High blood pressure
Blurred vision
Funny tummy
Head aches
Loss of appetite
Generally feeling very unwell, he has been in bed for the last 2 days. Could any one tell me when he is likely to feel better soon. We managed to get hold of the Teva brand last night so he has taken 2 lots of them, he normally takes 2 tablets in the morning and night.
Thanks

Submitted by Philippa Jones on

Hi

I hope your husband is feeling better. If not you may wish to see his GP just to check there isn’t anything else going on. 

Some people have experienced side-effects that they have not had before when they change from one make of epilepsy medicine to another. We explain some possible reasons for why this may happen on our webpage consistency of supply.

If it’s thought to be the change of this epilepsy medicine that has made your husband so unwell, there are a few things you could do. 

You could ask the GP to write the manufacturers name on your husband’s future prescriptions. But your pharmacist doesn’t have to take any notice of this

Talk to your chemist. Ask if they will always try get him the same make of your husbands lamotrigine. You could down load information from this webpage and the consistency of supply to help explain the situation to your chemist.

You may also consider logging a report through the Yellow Card Scheme. This is so the MHRA can make changes to their guidance about prescribing epilepsy medicines, if necessary.

If you would like to discuss this further, please feel free to contact our helpline team directly. You can either email helpline@epilepsy.org.uk or phone the Epilepsy Action Helpline freephone 0808 800 5050. Our helpline is open Monday to Friday, 8.30am until 5.30pm.

Regards

Diane

Epilepsy Action Helpline Team

Submitted by rich on

Hi,
My pharmacist recently showed me that the import Keppra I get is manufactured in Sweden and then showed me that the UK version is also made there. They even had the same batch number and expiry date - the only difference was that the box i was dispensed had Spanish writing on it as it was sent there originally.

How then do I sometimes feel there's a difference because of the packaging if it's exactly the same inside??

Submitted by James Hughes on
Hi James
 
It can be confusing making sure you get the same make of medicine every time.
 
Keppra is made at a central production plant. The best way to make sure you have the same type every time is by looking at the tablets, as you did. And if the code and the colour of the tablet is the same they should be fine.
 
When the box is in a different language, Spanish in your case, this usually means it was packed for the Spanish market. Then a UK supplier has bought it from Spain as it’s probably cheaper than buying it from within the UK. This is known as parallel importing.
 
If it will help to discuss this further with our helpline team, please either emailhelpline@epilepsy.org.uk  or phone the Epilepsy Action Helpline freephone 0808 800 5050. Our helpline is open Monday to Friday, 8.30am until 5.30pm.
 
Regards
 
Diane
Epilepsy Action Helpline Team
Submitted by rich on

I had a brain tumour removed 9 years ago and started having seizures after the op, which have continued for the 9 years. ust recently my seaures started increasing in frequency, and besides being on Clonazapam (0.5mg), Phenytoin (375mg), my Neurologist started me on Lamotrigine 4 months ago. I have been on Lamotrigine Torrent but this week was given Lamotrigine Accord by my Pharmacist...is there a difference between these two names, please? My seizures have not decreased yet in the 4 months, the severity has increased, but I guess its early days yet.

Submitted by Sheila Hume on

Hi. My 23 year old son has had epilepsy for 20 years and, for the last 7 has been very well controlled on a combination of Levitiracetam and Epilim chronos. He used to be prescribed Keppra but is now on generic versions which vary according to what the pharmacist has in stock. He has had no problems with the generic versions (to date). However, I have just picked up his monthly repeat prescription and the box contains tablets from 5 different manufacturers - it looks as if they have used the odds and ends from different boxes as they are not even all complete strips, cut from others. Am I right to find this concerning? They are all the same colour but some are smaller than others. Please advise whether I am within my rights to ask the pharmacist to change them for all the same brand. I have used the same pharmacy for years but it has recently been taken over and this is the first time this has happened. Thank you.

Submitted by Lauraine Reynolds on

My 29-year-old son with learning difficulties, developed epilepsy a year ago. Since being prescibed levetiracetam in June he has been seizure free. He's been given a couple of the unbranded forms, but mostly the one manufactured by Rosemont. He has now been given the Keppra version but since taking it has been very sleepy and just not himself. He does not speak so we can only go by what we observe.
I have scoured the local chemists and today have contacted Rosemont but they have no idea when it will be available again.
Has anyone had similar problems? What other unbranded forms of levetiracetam might be ok?

Submitted by Wendy on

Hi Wendy

 

It must be worrying to see your son reacting differently to his medicine. Some people do find that they get different side-effects when they have to switch from one version of their medicine to another. It’s worth discussing any new symptoms with your son’s doctor to check if anything else could be causing his sleepiness.  

 

We can’t advise on what other types of levetiracetam would be suitable, but here is a link to different versions of levetiracetam that have been licenced in the UK. Perhaps you could discuss it with your pharmacist to see which ones they can get hold of.

 

Best wishes

Grace

Epilepsy Action Helpline Team

Submitted by rich on

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