Switching between different versions of epilepsy medicine

Should I be worried if I get a different version of my epilepsy medicine?

We know how important it is to get the right epilepsy medicines if you have epilepsy. Taking your medicines correctly is vital for keeping your seizures under control.

Sometimes you might get a different version of a medicine to the one you normally have. It’s understandable to worry about whether this may affect your seizure control. But there are strict rules to reduce the chance of this happening.

This page explains why you might be given a different version and when it’s important to stay on the same version.

Why are there different versions of my epilepsy medicine?

Many medicines are available in both branded and generic versions. This includes most epilepsy medicines too. Branded and generic medicines are different forms of the same medicine.

Branded medicines

This is how a medicine is sold when it’s first created by a pharmaceutical company. The company that develops it usually takes out a patent. This means that only they can sell it, under a brand name they have created.

Generic medicines

These are different versions of the branded medicine, containing the same active ingredient. The active ingredient is the part of the medicine that helps your condition.

Other companies can start making their own versions of the medicine once the original company’s patent runs out.

Branded generics

Most generic versions of a medicine will just use the name of the active ingredient. But sometimes a company will give their generic version its own brand name. These are known as branded generics.

An example

An example is the epilepsy medicine levetiracetam. This is the active ingredient. The branded version is called Keppra. But there are also a number of generic versions with the name levetiracetam.

We have a list of the epilepsy medicines available in the UK, including their generic and brand names.

Why have I been given a different version of my epilepsy medicine?

There are various reasons why you might get a different version of your medicine.

Cost

Doctors aim to prescribe generic medicines when they can, as they tend to be cheaper for the NHS. This is called generic prescribing. It means your pharmacist can give you any equivalent version of the same medicine.

Supply problems

Sometimes there may be supply issues with your usual version of epilepsy medicine. This could be due to:

• The manufacturer has run out of stock. This could be because of a manufacturing problem or an increase in demand
• Your pharmacy, or the wholesalers that supply your pharmacy, are out of stock
• The manufacturer has stopped making the medicine.

Being able to prescribe a different version of your usual medicines reduces any delay in you getting your medicines.

Are there any differences between different versions of my epilepsy medicine?

Whatever version of epilepsy medicine you have, the active ingredient should be the same. For example, every version of levetiracetam 250mg tablets should contain 250mg of levetiracetam.

However, all medicines have other ‘inactive’ ingredients as well as the main one. These can be different, depending on who makes the medicine.

These other ingredients can affect how well a medicine is absorbed in your body. This could make a difference in how well the medicine works too. But any new generic medicine must be shown to be ‘bioequivalent’ to the original medicine. This means there should be no noticeable differences in how it acts in the body.

Different versions of a medicine will also look different. Some medicines also come in coated and uncoated versions. They may be a different colour, size or shape. They will also have different packaging.

Could switching between different versions of my medicine be a problem?

Your pharmacist should only give you a different version of your epilepsy medicine if it’s considered safe to do so. This means the risk of it causing problems is extremely low. There are rules around this for epilepsy medicines, which we explain in the next section.

But some people say that switching versions does cause a change in their seizures. Others may have a breakthrough seizure after previously being seizure-free. Some people might also have different or more side effects.

There could be a number of reasons for this:

• It could be due to chance. It might be a coincidence that these changes happened at the same time you switched medicine
• It might be due to not taking the new version of the medicine correctly. You may find it harder to take, perhaps due to a change in size or taste. Or differences in the packaging may create confusion with taking the correct dose
• The small differences between versions and how they’re absorbed could affect how well they work in some people. Although this is thought to be unlikely for most medicines, experts can’t rule it out. This risk varies depending on which medicine you take.

How can I get the same version of my epilepsy medicine?

If you and your doctor agree you should stay on the same version of your medicine, your doctor can write this on your prescription. They can ask for the brand name of the medicine, or a particular manufacturer’s generic version. Your pharmacist should always try to give you this version.

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

If your pharmacist doesn’t have your usual version in stock, you can ask for your prescription back and take it to another pharmacy. But if your usual version isn’t available anywhere, you may need to switch to a different version.

For some medicines, your pharmacist may be able to give you a different version straight away. But if your doctor has said that you need a particular version and this isn’t available, you should speak to your doctor.

Check this with your pharmacist if you’re not sure. Your doctor will check whether a different version is suitable for you. They can also monitor you if needed.

If you have any worries about taking a different version, talk to your GP, pharmacist, or epilepsy doctor or nurse. Some epilepsy specialist nurses are able to prescribe your medicine.

You can also call our helpline if you have any questions. For most people, it’s safer to take a different version of their medicine than to run out and stop taking medicine suddenly.

For the latest updates on epilepsy medicine shortages, visit our drugwatch page.

How can I report problems with my epilepsy medicines?

If you think your epilepsy medicine is causing problems, talk to your GP. They can report these issues to the MHRA. You can also report side effects yourself online using the MHRA’s Yellow Card site.