You are here

Medicines for seizures

Categories:
  • Organisations we regulate

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.

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

Considerations

Women and girls of child bearing age must be enrolled in a Pregnancy Prevention Programme if they are taking valproate.

Do not suddenly stop AEDs. This could result in the person experiencing a seizure, or other side effects. Staff must take extra care to ensure adequate stocks of AEDs are available.

NICE guidance states that stopping or reducing the dose of AEDs must be managed by, or be under the guidance of, the specialist. Staff need to be aware of any dose changes and make sure that AEDs are given regularly at the prescribed dose.

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 is in the patient information leaflets supplied with the medicines.

Prescribing categories

Switching between different brands of AED may cause side effects or loss of seizure control.

There are three risk-based categories of AED based on their physical properties.

Category 1

Includes:

  • carbamazepine
  • phenytoin
  • primidone
  • phenobarbital.

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.

Category 2

Includes:

  • valproate
  • lamotrigine
  • topiramate.

The person and their doctor should decide whether it’s best for them to remain on a specific brand.

Category 3

Includes:

  • levetiracetam
  • gabapentin
  • pregabalin.

It’s usually unnecessary for people to remain on a specific brand.

Rescue medicines

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

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

Care staff supporting people with rescue medicines should be trained and competent to be able to administer them. Administration of buccal midazolam is not a nurse delegated task. Make sure the quality of training meets the Epilepsy Nurses Association (ESNA) guidelines.

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
  • reorder before the expiry date.

NICE guidance states that you should call an ambulance if:

  • seizure continues 5 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:
09 September 2020