Navigating Generic vs. Brand-Name Epilepsy Medication

If you live with epilepsy, you’re likely aware of how important consistency is for managing your seizures. This is especially true when it comes to taking prescribed medication. But have you ever picked up your Anti-Seizure Medication (ASM) and noticed the packaging or tablet looked different? Whether it’s a switch from branded to generic, or between different generic versions, it’s natural to feel concerned. Here’s what you need to know about switching between different types of medication and how safety classifications, like those from the MHRA, guide consistent treatment decisions.

Why Do We Have Generic and Brand Versions of Anti-Seizure Medication?

There are many ASMs available to treat epilepsy, and finding the one that works for you can be a complicated journey. This can become even more complicated when you discover multiple versions of what appears to be the same product.

When a pharmaceutical company develops a new ASM, it sells the product under a specific brand name. They also file for a patent, which is a legal protection that prevents anyone else from copying and selling the drug for a set period. Once that patent expires, the drug enters the public domain, and other companies can then legally manufacture and sell their own versions. These are known as generic drugs.

Generic drugs must meet the same high standards of quality and manufacturing as the brand-name product. They can differ in colour, size, shape, and inactive ingredients such as fillers or dyes, but the active ingredients must be the same as the original brand-name product. They must also prove to be bioequivalent, meaning they deliver the same amount of active ingredient into the bloodstream in a similar timeframe.

Why Your Epilepsy Medication May Change

ASMs may be switched out for various reasons, such as cost. Generic medications are generally less expensive than branded ones. Health systems such as the NHS often encourage generic prescribing to reduce costs.

Another reason may be supply shortages. If a manufacturer runs out of stock or discontinues a product, pharmacists may dispense an alternative version.

Whatever the reason, these changes must be handled with care to avoid risks to your seizure control. This is exactly why consistency is so prioritised in prescribing, and why regulatory bodies like the MHRA have created guidelines to manage these switches safely.

Consistency Matters More Than Brand

The differences between generic and brand-name medications don’t affect the core function of the ASM. Therefore, we can’t presume that one version is ‘better’ or ‘worse’ than the other. The concern, however, lies with switching between versions of the same ASM. As mentioned earlier, consistency is key in effectively managing epilepsy.

For many people, switching between versions is considered safe. But for others, even small changes in the formulation can lead to breakthrough seizures or new side effects. To support consistent care, the MHRA groups ASMs into three categories based on the risk associated with switching between different versions of the product.

   Category 1: High Risk

These are the most sensitive ASMs. For drugs like Phenobarbital, Primidone, Phenytoin, and Carbamazepine, small differences between manufacturers’ products can lead to noticeable changes in seizure control. Patients should stay on the same version of this medication.

   Category 2: Moderate Risk

ASMs in Category 2 can be switched based on the recommendation and judgment of your healthcare professional. Medications from this category include Sodium Valproate, Lamotrigine, Perampanel, Clobazam, and more.

When your doctor considers switching you from a branded to a generic medicine, they will look at several factors, including how stable your condition is on your current medication. If you are doing well on a branded ASM, your doctor may suggest continuing with it to avoid any potential disruption. Other considerations include whether you are comfortable taking medication that looks or tastes different, and whether a change could cause you any concern or anxiety. Your preferences and feelings are important parts of this decision.

   Category 3: Low Risk

ASMs in this category, such as Brivaracetam, Ethosuximide, and Gabapentin, carry a very low risk when switching between different versions. This means they are the most flexible group when it comes to switching between branded and generic medicines. If you take ASMs in this category, there’s usually no need to stay on a particular version. However, we recommend always consulting a healthcare professional before making any changes to your medication or routine.

A Right to Consistent Care

When it comes to treating epilepsy, the debate over branded versus generic ASMs often misses the most important point: the need for consistent treatment.

While generic versions are less expensive and work the same way for most people, even small changes in how a drug is made can seriously affect seizure control for others. The MHRA’s classification system provides a valuable framework for guiding safe prescribing. However, success truly depends on patients, family members, and healthcare professionals all communicating clearly to ensure steady and consistent treatment. For many patients, staying on the same version of their ASM, whether it’s the brand name or the generic, is the safest choice.

This principle of safe, consistent, and informed treatment decisions is central to themes like ‘Our Risk, Our Rights,’ reminding us that people with epilepsy deserve clear facts about their risks and the right to advocate for their care.

If you are worried about any changes to your treatment, you have the right to speak up and act:

• Talk clearly with your doctor.
• Ask your GP to specify the brand or manufacturer on your prescription.
• Request that your prescription says “do not substitute.”