Eslicarbazepine


  Issues for Surgery


Precipitation of rebound seizures or status epilepticus if omitted.


  Advice in the Perioperative period


Elective and Emergency Surgery

Continue – check sodium levels pre-operatively (see Further Information).

Patients should be advised to take their regular medications on the morning of surgery1, 2, 3.

Abrupt withdrawal of any anticonvulsant drug should be avoided1.

Confirm with the patient if they need to be maintained on a specific manufacturer’s product (see Further Information).

Post-operative Advice

The patient’s usual oral medication should be re-commenced in the immediate post-operative period2, 3.

Eslicarbazepine is only available as oral preparations. If the patient cannot resume their usual oral medication post-operatively, the advice of a Neurologist should be sought to determine the most appropriate antiepileptic preparation, dose, route and frequency to be used.

Monitor renal function and electrolytes, particularly sodium (see Further Information).


  Interaction(s) with Common Anaesthetic Agents


None1, 2, 3, 4.

For general information regarding the use of anaesthetic agents in patients with epilepsy – see Antiepileptics – A General Overview.


  Interaction(s) with other Common Medicines used in the Perioperative Period


For general information regarding the use of antiemetics in patients with epilepsy – see ‘Antiepileptics – A General Overview.

Omeprazole

Eslicarbazepine is predicted to increase the exposure to omeprazole – monitor for an increase in omeprazole adverse effects and adjust the dose of omeprazole if necessary4.


  Further Information


MHRA/CHM Advice: Antiepileptic Drugs: updated advice on switching between different manufacturer’s products (November 2017)1

Eslicarbazepine is a category 2 antiepileptic, hence the need for continued supply of a particular manufacturer’s product should be based on clinical judgement and consultation with the patient and / or carer taking into account factors such as seizure frequency treatment history, and potential implications to the patient having a breakthrough seizure. Non-clinical factors such as patient anxiety, confusion, potential for dosing errors should also be considered (For more information see Antiepileptics – A General Overview).

Hyponatraemia

Hyponatraemia can occur with eslicarbazepine1, 5. The frequency of hyponatraemia increases with increasing eslicarbazepine dose5. Monitor plasma sodium concentration in patients at risk of hyponatraemia (e.g. concurrent use of Non-Steroidal Anti-inflammatory Drugs (NSAIDs)). The manufacturer of eslicarbazepine advises to discontinue the medication if clinically relevant hyponatraemia occurs1, 5; however, this should only be performed under the supervision and advice of a Neurologist.


  References


  1. Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press http://www.medicinescomplete.com [Accessed 30th June 2019]
  2. Perks A, Cheema S, Mohanraj R. Anaesthesia and epilepsyBJA: British Journal of Anaesthesia. 2012; 108(4):562-571
  3. Carter EL, Adapa RM. Adult epilepsy and anaesthesia. BJA Education 2015; 15(3):111-117
  4. Baxter K, Preston CL (eds), Stockley’s Drug Interactions (online) London: Pharmaceutical Press. http://www.medicinescomplete.com  [Accessed on 30th June 2019]
  5. Summary of Product Characteristics – Zebinix® (eslicarbazepine) 800 mg tablets. Eisai Ltd. Accessed via www.medicines.org.uk 30/06/2019 [date of revision of the text June 2019]