Issues for Surgery
Precipitation of rebound seizures or status epilepticus if omitted.
Advice in the Perioperative period
Elective and Emergency Surgery
Patients should be advised to take their regular medications on the day 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).
Regular dosing of the patient’s usual oral medication should be re-established as early as possible post-operatively2, 3.
Ethosuximide is only available as oral preparations. If patients 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.
Interaction(s) with Common Anaesthetic Agents
None1, 4, 5, 6.
For general information regarding the use of anaesthetic agents in epilepsy patients – 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 epilepsy patients – see ‘Antiepileptics – A General Overview’.
Concomitant use of ethosuximide with the following can increase the risk of myelosuppression1: -
Whilst single surgical prophylactic doses should not pose a problem, continued post-operative treatment may require close monitoring. Consult current product literature.
MHRA/CHM Advice: Antiepileptic Drugs: updated advice on switching between different manufacturer’s products for a particular drug (November 2017)1
Ethosuximide is a category 3 antiepileptic, hence it is usually unnecessary to ensure that patients are maintained on a specific manufacturer’s product as therapeutic equivalence can be assumed. However, other factors are important when considering if switching is appropriate such as patient anxiety, risk of confusion or dosing errors. (For more information see ‘Antiepileptics – A General Overview’).
Blood dyscrasias (leucopenia, agranulocytosis, aplastic anaemia and pancytopenia) have been reported with use of ethosuxmide6. Patients should be monitored for sign of blood disorders (e.g. fever, mouth ulcers, bruising, or bleeding)1. Withdrawal of the drug may be necessary and the patient’s Neurologist should be consulted to ensure an appropriate management plan.