For further information on individual agents, please refer to specific monographs
Antiepileptic Drugs (AEDs)
Interactions between AEDs and other medicines are sometimes complex. They are usually caused by hepatic enzyme induction or inhibition. Interactions can be highly variable and unpredictable.
Antiepileptic drugs should be withdrawn under specialist supervision1. Abrupt withdrawal should be avoided as it can precipitate severe rebound seizures1. There is usually no clinical reason for epilepsy patients undergoing surgery to withdraw from their medication.
Agents Use in Anaesthesia
Many of the agents used in anaesthesia possess both pro-convulsant and anticonvulsant properties, which could impact on the choice of anaesthetic.
Intravenous (IV) Anaesthetics
Neuromuscular Blocking Drugs (NMBDs)
Anticholinergics and Anticholinesterases
Dopamine antagonists are especially associated with extrapyramidal effects and acute dystonic reactions, which might be confused with seizure activity. It is advisable to avoid phenothiazine antiemetics (e.g. prochlorperazine) and metoclopramide in patients with history of seizures3.
MHRA/CHM Advice: Antiepileptic Drugs: updated advice on switching between different manufacturer’s products (November 2017)1
The following advice relates only to antiepileptic drugs used for treatment of epilepsy; it does not apply to other indications (e.g. mood stabilisation, neuropathic pain):-
If the prescribed product is unavailable, it may be necessary to dispense a product from a different manufacturer to maintain continuity of treatment. Such cases should be agreed with both the prescriber and the patient (or carer).