Rufinamide


  Issues for Surgery  


Precipitation of rebound seizures or status epilepticus if omitted.


  Advice in the Perioperative period


Elective and Emergency Surgery

Continue.

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).

Post-operative Advice

Regular dosing of the patient’s usual oral medication should be re-established as early as possible post-operatively2, 3.

Rufinamide 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.


  Interaction(s) with Common Anaesthetic Agents


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

Alfentanil

Rufinamide is predicted to decrease the exposure to alfentanil. Monitor for a reduction in alfentanil efficacy, and adjust the dose if necessary4.

Midazolam

Rufinamide is predicted to decrease the exposure to midazolam. Monitor for a reduction in midazolam efficacy, and adjust the dose if necessary4.


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


Antiemetics

Rufinamide is predicted to decrease the exposure to domperidone. Monitor for a reduction in domperidone efficacy, and adjust the dose if necessary4.

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


  Further Information


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

Rufinamide 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).

 

  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 epilepsy. BJA: 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 20th July 2019]