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Medicines for seizures

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Anti-epileptic drugs (AEDs) are used to prevent seizures.

This can include seizures caused by epilepsy as well as non-epilepsy seizures. Examples of commonly prescribed AEDs include:

  • Phenytoin
  • Carbamazepine
  • Lamotrigine
  • Levetiracetam
  • Sodium valproate
  • Pregabalin
  • Gabapentin
  • Oxcarbazepine
  • Topiramate

Considerations

Some of these medicines may be used for other medical conditions. Staff should check what they have been prescribed for.

NICE guidance on epilepsy advises against blood test monitoring in adults as routine. You should only monitor blood tests if there is a particular clinical reason.

Do not suddenly stop AEDs. This could result in the person experiencing a seizure, or other side effects. Most medicines administration records (MARs) will contain an instruction below the name of the medicine stating that it should not be stopped without the advice of a doctor.

NICE guidance states that stopping or reducing the dose of AEDs must be managed by, or be under the guidance of, the specialist. Staff should make sure that AEDs are given regularly at the prescribed dose.

Staff need to be aware of any dose changes and ensure that adequate stock of medicines are available.

AEDs interact with many medicines. If the person starts a new medicine, the GP and pharmacist should check for any interactions. If the person needs an over the counter medicine, consult the pharmacist first. You must tell the pharmacist that the person is taking AEDs.

Carers should have access to information about the side effects of AEDs. This information should be readily available on patient information leaflets that are supplied with the medicines.

There are three categories of AED based on their physical properties. Category one includes carbamazepine, phenytoin, primidone and phenobarbitone. People prescribed AEDs from this category should remain on a specific manufacturer’s product. There should be no switching between brands. This reduces the likelihood of loss of seizure control or worsening of side effects. Read the leaflet for patients and carers.

Rescue medicines

These medicines are sometimes prescribed as rescue medicines to treat seizures:

  • midazolam (for buccal administration)
  • diazepam (for rectal administration)

Care plans should include:

  • information about how the seizure presents itself
  • details about people’s rescue medicines. This should include what effect these should have and within what time frame
  • when staff need seek more help. For example, when to call for an ambulance

If people have been prescribed rescue medicines, make sure you keep appropriate quantities in stock.

Where staff are responsible for administering, they must have the relevant training and competence to do so.

NICE guidance states that you should call an ambulance if:

  • seizure continues five minutes after administering emergency medicines
  • the person has a history of frequent episodes of serial seizures
  • the person has convulsive status epilepticus
  • this is the first episode requiring emergency treatment
  • there are concerns or difficulties monitoring the person's airway, breathing, circulation or other vital signs
Last updated:
17 June 2019

 


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