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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.

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: 
F051.08

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 29 comments or add yours

Comments

I will be in the process of choosing insurance plans in October this year. However, according to my pharmacist, I have to submit a letter from my neurologist along with a letter from me saying that generic for Lamictal XR is not good. That is the only way the insurance will accept it and not be given generic name. Why do I have to go through this every year?

Submitted by Vickie kelley on

Hello Vickie

Many thanks for your message. This sounds like a frustrating situation to be in.

As you have already seen, in the UK we have guidance about when a person needs to be prescribed a specific manufacturer’s product, and when they can be prescribed a generic one. Doctors and Pharmacists in the UK health system are made aware of these guidelines, and should follow them. This does not always happen though.

The healthcare system in the USA is very different to the UK one, so we do not encounter the problems with health insurance companies in the same way as you do. It must be very trying for you. You may find it helpful to contact the Epilepsy Foundation who are based in the USA. They have information about health coverage and may be able to put you in contact with people in a similar situation.

Karen
Epilepsy Action Advice & Information Team

Submitted by Karen, Epilepsy... on

My complex partial seizures started 30 years ago and the best control came with lamital
and Keppra. I have continued to have seizures though.

I tried Zonisamide to see if it would make me feel more alert.I had a clonic tonic seizure.I went back to the old medications

Last year out of the blue my pharmacist gave me lamotrogine instead of Lamictal and I did not query it as I was complacent and believed that it would be OK. Later last July the hospital epilepsy nurse prescribed Levetiracetam and that has been made by all sorts of companies here and abroad. When I came off Keppra in the switch over time I had a nasty breakthough seizure but thought it a one off.(THEY must be right!!)
Now on 3000mg levertiracem and 400mg lamotrogine I have to sleep 10hrs a night and wake drowsy. The medication may have lessened and they are complex partial seizures again but I feel sleepy all the time.
The epilepsy nurse thinks I may have to change medicines but about 18 months ago she said other medicines were unlikely to work better .We did not talk of side affects at all. She does not think going back to the branded versions will work any better but I want to try. I don't want the Zonisamide type affects again.

Has anyone else experienced problems like this with these 2 drugs?

Submitted by Sue Day on

Hi Sue

It sounds like you’ve been on quite a journey. The juggle between getting the best seizure control and dealing with side-effects, is really tricky isn’t it. And as you probably know, the amount of epilepsy medicine you are taking is at the very top end of what is usually recommended. So that in itself is likely to make you drowsy.

It may be worth asking your GP if they are prepared to change you back to the Keppra. You could suggest that as it had fewer side-effects for you, you would be likely to need fewer appointments if your general health improved.

If you want feedback from other people your best chance of feedback is on our online community, forum4e. But it’s worth bearing in mind that everyone reacts differently to different medicines.

I really hope you are able to get a better balance between seizure control and side-effects.

Cherry
Advice and Information Team

Submitted by Cherry, Epileps... on

Just wonder if you can advise us..my daughter has always been given lamotogiene made by Teva but I cannot get it anywhere .. the pharmacist said for this drug it is ok to use another brand but we are just so worried

Submitted by tracy wells on

Like Tracey I have been on Teva lamotrigine for 3 years and now my pharmacist has given me different makes twice in the last 3 months, saying Teva is not available. This worries me as I do not want to have more seizures and lose my licence again.

Submitted by E Jeffries on

Dear E Jeffries

Thank you for your comment. It’s such a worrying and anxious time when epilepsy medicine becomes unavailable.

But we’re pleased to say, Teva lamotrigine of all sizes are now back in stock.

If your chemist is still having difficulties getting them, they could contact Teva directly.

For your information the The Medicines and Healthcare Products Regulatory Agency (MHRA) have set new guidelines for generic prescribing of epilepsy medicine.

Regards

Diane Wallace

Advice and Information Team

Submitted by Diane Wallace on

I take tegratol retard 1200mg twice a day and clobazam 20mg in the evening, had the problem of different brands being supplied and side effects galore double vision, slurred speach, generally being unable to function. Still having seizures developing into double and tripple seizures lasting upto an hour never thought anything with regards to where my medication was coming from, having had this happen again this week but having eight seizures and being induced into a medical coma the medication and there whereabouts are playing a big factor in the treatment of my epilepsy and I am now making sure they are novartis british brand. If this doesn't work then I am back to square 1 after suffering for 27 years with no real let up :-(

Submitted by Trevor hampson on

Hi Trevor

It’s definitely worth a try.

If you have tried various epilepsy medicines and still having seizures, have your doctors looked at other possible treatment options for you. To see what these could be please view our webpage, other ways of treating epilepsy. https://www.epilepsy.org.uk/info/treatment/other-ways-treating-epilepsy

You may also wish to view our information on getting the right treatment and care.

I hope things go well.

If we can be of any more help, 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 Wallace
Epilepsy Action Advice and Information Team

Submitted by Diane, Epilepsy... on

I had been seizure free for 13 years , a week before Xmas I was given a different brand of my medication by the pharmacist , although I had , had variations of my medication before but this particular one caused me to have 3seizures in 1 and a half hours the latter two caused panic amongst the paramedics as they struggled to find a pulse and my breathing was almost non existent coming out of the seizures. The impact on my life has been horrific , I work shifts and now can't get to work on public transport causing me to lose shift pay whilst off (the majority of my pay) my anxiety is through the roof most of the time. I started with a stutter after the seizures and my head still doesn't feel like it's working properly almost three months after. Back on the proper brand so no more seizures but life turned upside down , all for government savings .

Submitted by Wes on

My husband has lamotrigine and has always had Actavis brand which has now been discontinued. I know he is very worried about using the lamictal ones he has been given but he has no choice.

Submitted by Sylvia Watkinson on

Hi Sylvia 

It’s understandable your husband’s worried.  We hope the change goes well.

Could your husband let us know how things go or post something on our drugwatch page. This may help others facing the same situation. 

If we can be of any help to you both, please feel free to contact us again, either by email helpline@epilepsy.org.ukor the Epilepsy Action Helpline freephone 0808 800 5050. Our helpline is open Monday to Friday, 8.30am until 5.30pm. 

Regards D

Diane

Epilepsy Action Advice and Information Team

Submitted by Diane on

A follow up to my earlier post. The change of brand of my husbands Lamotrigine has thankfully been incident free in the 4 months since changing. Our pharmacy says the new brand should be regularly available so hope to good for the future.

Submitted by Sylvia Watkinson on

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