• Approved for use as adjunctive therapy in patients with severe/intractable partial onset seizures e.g. a sezuire frequency of 1 per week following failure of first-line adjunctive therapy. Response must be assessed within 3-6 months before transferring prescribing to primary or stopping treatment, as appropriate.

• 100mg/1mL oral solution
  • Approved for use in combination with clobazam for treating seizuires associated with Dravet syndrome in people aged 2 years and older
  • Approved for use in combination with clobazam for treating seizures associated with Lennox-Gastaut syndrome
  • Approved as an add-on treatment option for seizures caused by tuberous sclerosis complex in people aged 2 years and over - in line with NICE TA873.

• Carbamazepine 200mg and 400mg MR tablets (Tegretol® retard) are available on consultant request for those in whom conventional carbamazepine has been shown to be unsuitable 

• 125 mg and 250 mg suppositories

• Note: licensed for short-term use as replacement therapy (maximum period recommended: 7 days) in patients for whom oral treatment is temporarily not possible, for example in post-operative or unconscious subjects.

• Clonazepam 500microgram in 5ml sugar-free oral solution is also approved unlicensed

• Approved for use by specialists only in those patients for whom intolerance of carbamazepine is a major concern and when use of this agent is more cost effective than alternatives available.

Oral solution: 2.2mg/mL

• Note: gabapentin 250mg in 5ml is also approved unlicensed.

• Only approved on advice from consultant neurologists, in patients that are refractory to treatment with other drugs.

• Injection is also approved for use in palliative care 

• NETAG approved for partial (focal) seizure epilepsy only when other treatment  options recommended by NICE have been tried or fully considered.

• 15mg/5ml oral solution
  • not suitable for use in children
• 50mg/5ml alcohol free oral solution e.g. Rosement (unlicensed)
  • to be used for all children (<18yrs) who require a liquid preparation. 

• Note: phenytoin 30mg in 5ml suspension (base) – 90mg (15ml) is equivalent to one 100mg phenytoin sodium capsule 250mg in 5ml injection (sodium salt).

• Approved for specialist advice in the management of treatment resistant epilepsy. 
• Also approved as a second line agent for General Anxiety Disorder. Although treatment can be given 2-3 times daily, it is more cost effective to give as a twice daily dose. 

• Approved for limited use as a second or third-line treatment in patients with Lennox-Gastaut syndrome and related encephalopathies.
• Should only be used on the advice of paediatric neurologists and other neurologists specialising in the treatment of epilepsy.

• Note: sodium valproate 500mg & 1000mg MR granules (Episenta®) - for possible use in those who have difficulty swallowing sodium valproate tablets. May be more convenient to use than large volumes of liquid formulations.
• Valproate▼ must no longer be prescribed to women and girls of childbearing potential unless there is no alternative and they are on the Pregnancy Prevention Programme (PPP) 

▼ BLACK TRIANGLE IN FEMALES

Valproate must no longer be prescribed to women and girls of
childbearing potential unless there is no alternative and they are on the
Pregnancy Prevention Programme (PPP)

For information relating to alerts regarding valproate, including Drug Safety Updates and links to PPP materials, please use the following link:

MHRA Drug Safety Updates (valproate)

Valproate (Belvo, Convulex, Depakote, Dyzantil, Epilim, Epilim Chrono or Chronosphere, Episenta, Epival, and Syonell▼): new safety and educational materials to support regulatory measures in men and women under 55 years of age (MHRA Drug Safety Update January 2024)

Valproate use in men: as a precaution, men and their partners should use effective contraception (MHRA Drug Safety Update September 2024)

Valproate (Belvo, Convulex, Depakote, Dyzantil, Epilim, Epilim Chrono or Chronosphere, Episenta, Epival, and Syonell▼): review by two specialists is required for initiating valproate but not for male patients already taking valproate. (MHRA Drug Safety Update February 2025)

Valproate must no longer be prescribed to women and girls of
childbearing potential unless there is no alternative and they are on the
Pregnancy Prevention Programme (PPP)

For information relating to alerts regarding valproate, including Drug Safety Updates and links to PPP materials, please use the following link:

MHRA Drug Safety Updates (valproate)

Valproate (Belvo, Convulex, Depakote, Dyzantil, Epilim, Epilim Chrono or Chronosphere, Episenta, Epival, and Syonell▼): new safety and educational materials to support regulatory measures in men and women under 55 years of age (MHRA Drug Safety Update January 2024)

Valproate use in men: as a precaution, men and their partners should use effective contraception (MHRA Drug Safety Update September 2024)

Valproate (Belvo, Convulex, Depakote, Dyzantil, Epilim, Epilim Chrono or Chronosphere, Episenta, Epival, and Syonell▼): review by two specialists is required for initiating valproate but not for male patients already taking valproate. (MHRA Drug Safety Update February 2025)

• For use as adjunctive therapy of refractory generalised tonicclonic seizures in children with severe myoclonic epilepsy in infancy.

• For use only in patients that are refractory to treatment with other drugs on the recommendation of a specialist

• Use in children is unlicensed.