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.
If patients are unable to take their regular oral medication post-operatively, consider using the oral powder sachets via the rectal route [unlicensed use]1. The rectal dose and frequency should be the same as the established oral dose. Alternatively, seek the advice of a Neurologist to determine an appropriate medication, dose, route and frequency.
Interaction(s) with Common Anaesthetic Agents
None1, 4, 5, 6.
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
None1, 4, 5, 6.
For general information regarding the use of antiemetics in patients with epilepsy – see ‘Antiepileptics – A General Overview’.
MHRA/CHM Advice: Antiepileptic Drugs: updated advice on switching between different manufacturer’s products (November 2017)1
Vigabatrin is a category 3 antiepileptic, hence it is usually unnecessary to ensure that patients are maintained on a specific manufacturer’s product unless there are specific concerns such as patient anxiety, and risk of confusion or dosing errors. (For more information see ‘Antiepileptics – A General Overview’).
Liver Function Tests (LFTs)
Vigabatrin may lead to a decrease in measured plasma activity of alanine aminotransferase (ALT) and to a lesser extent, aspartate aminotransferase (AST). The magnitude of suppression for ALT has been reported to vary between 30% and 100%. Bear this in mind if it is necessary to check LFTs pre-operatively as these liver tests may be quantitatively unreliable in patients taking vigabatrin6.