Medicines for seizures

Anti-epileptic medicines are used to prevent seizures.

This can include seizures caused by epilepsy as well as non-epilepsy seizures. The British National Formulary includes examples of commonly prescribed anti-epileptic medicines. Some of these medicines may also be used for other medical conditions. Staff should therefore check what they have been prescribed for.

Safety considerations 

For some medicines, a person must keep using a specific manufacturer’s brand and must not switch between brands. Switching between different brands of an anti-epileptic medicine may cause the side effects to worsen or loss of seizure control. You should work with people’s healthcare professionals to minimise these risks. Guidance from NICE explains how to minimise the risks.

It is vital that people do not suddenly stop taking anti-epileptic drugs. This could result in them experiencing a seizure, or other side effects. Staff must take extra care to ensure adequate supplies of anti-epileptic drugs are available to minimise the risk of missed doses.

Staff need to be aware of any dose changes and make sure that anti-epileptic drugs are given regularly at the prescribed dose.

Anti-epileptic drugs interact with many medicines. The GP and pharmacist should check for any interactions when a person starts a new medicine. If the person needs an over-the-counter medicine, you should consult the pharmacist first. You must tell the pharmacist that the person is also taking an anti-epileptic drug.

Carers should have access to information about the side effects of anti-epileptic drugs. This information is in the patient information leaflets (PIL) supplied with the medicines.

You should make sure that there is a detailed care plan, which describes how staff will support a person taking medicines to treat or prevent seizures. This could include:

• how to recognise a seizure
• what action to take to keep a person safe
• when to seek specialist or emergency support. 

Rescue medicines

The rescue or emergency medicines to treat a seizure in community settings are: 

• midazolam (for buccal administration into the buccal cavity in the mouth between the cheek and the gum)
• diazepam (for rectal administration)

Care staff supporting people with emergency rescue medicines must be trained and competent to be able to administer them. Make sure the quality of training meets the Epilepsy Nurses Association (ESNA) guidelines.

You should agree a personalised emergency management plan with the person receiving care wherever possible. This could include:

• how to identify when the person is having a seizure
• details about people’s rescue medicines. This should include what effect these should have and within what timeframe
• when staff need to seek more help. For example, when to call for an ambulance.

If people have been prescribed rescue medicines, make sure you:

• support them to be safe when they spend time away from the service
• keep appropriate quantities in stock
• re-order before the expiry date.

Anti-epileptic drugs in pregnancy

Anti-epileptic drugs are crucial to control seizures and other epilepsy symptoms. In pregnancy, untreated epilepsy can cause harm to both the pregnant person and the unborn baby. However, use of these anti-epileptic drugs during pregnancy has been associated with a range of harmful effects on the baby.

Make sure that you support people to receive specialist healthcare advice if they are planning to become pregnant. Women, girls of child bearing age and people with child bearing potential must be enrolled in a Pregnancy Prevention Programme if they are taking valproate.