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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.

The Medicines and Healthcare products Regulatory Agency is wanting to review its guidance on the need for getting the right version of your epilepsy medicine. So it is holding a consultation this year (2017). We will update our information once the guidance has been reviewed.


Epilepsy Action believes that it is important that you get the same version of your epilepsy medicine, every time you pick up a prescription.

Generic prescribing

Nearly all medicines have a generic name and a brand name. The generic name is usually 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 is available for patients, it is under licence. This means that only the company that developed it can sell it. They will give it their own brand name. Once the licence runs out, any company can make the medicine, giving it a different brand name. The generic name stays the same.

Here are the generic and some brand names of some commonly used epilepsy medicines.

Generic name

Brand names







sodium valproate




If a doctor writes the generic name of your medicine on your prescription, a pharmacist can give you any brand of that medicine. This is called generic prescribing. To keep costs down, a pharmacist may choose to give you a cheaper version of a medicine.

Parallel imports

Some companies make the same medicine at factories in the UK and in several other countries. An example of this is the epilepsy medicine Tegretol, which is made in Italy and the Netherlands, as well as in the UK. Some chemists in the UK carry supplies of Tegretol from all three countries. So, if a pharmacist gives you Tegretol, it could have been made in any of those countries.

When medicines that are made in the UK are also imported from other countries for use in the UK, they are called parallel imports. There are a number of signs that your epilepsy medicine is a parallel import. For example, the packet may look different or have wording in another language.

The problem with generic prescribing and parallel imports

Generic prescribing and parallel imports mean there can be many different versions of one medicine.

Some people, who have switched to a different version of their epilepsy medicine, have noticed that they have had more, or different, seizures. Some people have also experienced side-effects that they have not had before.

For this reason, Epilepsy Action believes that people with epilepsy should always get the same version of their epilepsy medicine, wherever possible. This is called consistency of supply. However, not all doctors agree with this.

Advice for people who prescribe epilepsy medicine

The National Institute for Health and Care Excellence (NICE) is an independent organisation. They provide guidelines for treatment and care for people using the NHS in England, Northern Ireland and Wales.

NICE’s advice about prescribing epilepsy medicines

Consistent supply to the child, young person or adult with epilepsy of a particular manufacturer's AED [epilepsy medicine] preparation is recommended, unless the prescriber, in consultation with the child, young person, adult and their family and/or carers as appropriate, considers that this is not a concern.

The Medicines and Healthcare Products Regulatory Agency (MHRA) also gives guidance to people who prescribe medicine and to pharmacists. It is not official policy that must be followed, and Epilepsy Action does have some concerns about it.

The MHRA’s advice about prescribing epilepsy medicines

Category 1 – Phenytoin, carbamazepine, phenobarbital, primidone
For these drugs, doctors are advised to ensure that their patient is maintained on a specific manufacturer’s product.

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.

Category 3 - Levetiracetam, lacosamide, tiagabine, gabapentin, pregabalin, ethosuximide, vigabatrin
For these drugs it is usually unnecessary to ensure that patients are maintained on a specific manufacturer’s product unless there are specific concerns such as patient anxiety, and risk of confusion or dosing errors.

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 the brand is written on your prescription, the pharmacist must give you that specific brand, by law.

If your take an epilepsy medicine that is in category 2 or 3 of the MHRA guidelines, your doctor might not want to prescribe you the same brand. However, you could ask your doctor if you could stay on the same version if:

  • The thought of changing makes you feel anxious or confused, or

  • You think you have had side-effects or seizures because you have been prescribed a different version of your epilepsy medicine

You can ask your doctor to write ‘no parallel imports’ on your prescription, but the pharmacist doesn’t have to take any notice of this. However, you can insist that your epilepsy medicine is given to you with a Patient Information Leaflet and packaging that is written in English.

If your epilepsy medicine is not made in the UK, it may be impossible to get exactly the same version every time. It is advisable to discuss this with your GP (family doctor).

Reporting problems with epilepsy medicines

If you think that you are getting side-effects from your epilepsy medicine, or they have caused your epilepsy to change, talk to your GP (family doctor). They can report these issues to the Medicines and Healthcare products Regulatory Agency (MHRA).

You can also report side-effects yourself by completing a Yellow Card. These are available from your GP (family doctor), pharmacist or the Yellow Card scheme:
Tel: 0808 100 3352
Website: yellowcard.mhra.gov.uk

Epilepsy Action encourages you to use the Yellow Card scheme. This is especially important if you think that having the version of your epilepsy medicine changed might have caused any of the following:

  • A breakthrough seizure
  • Different seizures
  • Worse or more frequent seizures or
  • Worse side-effects

Please include details of the original version and the new version of your epilepsy medicine.

This is so the MHRA can make changes to their guidance about prescribing epilepsy medicines, if necessary.

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. 


Epilepsy Action would like to thank Professor Markus Reuber, Professor of Clinical Neurology at the University of Sheffield and Honorary Consultant Neurologist at the Sheffield Teaching Hospitals NHS Foundation Trust for his help in producing this information.

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

  • Updated January 2014
    To be reviewed January 2017

Comments: read the 17 comments or add yours


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.

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.

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.


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.

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


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.


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.

Submitted by Sue Mitchell on