Therapeutic AreaFormulary ChoicesCost for 28
(unless otherwise stated)
Rationale for decision / comments
Related guidance: NICE CG137 The Epilepsies: diagnosis and management in adults and children in primary and secondary care Updated Feb 2016
NICE pharmacological treatments
MHRA advice in 2103 stated
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 i.e prescibe by brand name
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 reasons such as patient anxiety and risk of confusion or dosing errors
Therapeutic AreaFormulary ChoicesCost for 28
(unless otherwise stated)
Rationale for decision / comments
Premonitory stage (pre-hospital)Midazolam Buccal solution

as Buccolam®
Pre-filled syringes
2.5mg/0.5ml (yellow label), 4=£82.00.
5mg/1ml (blue label), 4=£85.50.
7.5mg/1.5ml (purple label), 4=£89.00.
10mg/2ml (orange label), 4=£91.50.
Licensed in patients 18yrs and under.

There may be a risk if existing patients are changed from Epistatus® or other unlicensed specials to Buccolam unless there has been clear communication and training for the carer of the different strengths available
As Epistatus®
10mg/1ml pre-filled oral syringe
Epistatus® is licensed for use in the treatment of prolonged, acute convulsive seizures in children and adolescents aged 10 to less than 18 years, who have been diagnosed with epilepsy. Buccal midazolam is recommended by NICE for the management of prolonged acute convulsive seizures, and is preferred by most patients and carers compared to the administration of rectal diazepam.
Diazepam 10−20 mg given rectally

Formulation switching of antiepileptics drugs