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Gold, incentives and meh

Let’s practise in Lancaster

By Nerys Hairon

GPs are raising serious concerns about pharmacists switching branded anti-epileptic drugs

for generics without doctor


A survey of 435 GPs and neurologists found 70 per cent felt routine switching of epilepsy medication without GP or specialist approval was 'medically inappropriate and unacceptable'.

Pharmacists in the UK are not allowed to switch between different versions of drugs if GPs have specified a branded or generic version. But many GPs are unaware that if they do not specify the drug, pharmacists can switch them.

Some 57 per cent of GPs in the study were 'very concerned' about the level of epilepsy control following generic substitution.

The international survey of doctors, of whom more than a half were GPs and more than a third from the UK, also found 69 per cent were worried about an increase in breakthrough seizures in patients who were switched from a branded to generic drug without dose increases.

The researchers, whose study was published recently in Epilepsy and Behavior, concluded: 'It is clear further clinical evidence is needed to determine the precise outcomes associated with switching to a generic drug.

'In the meantime, clinicians, pharmacists and patients must be fully informed as to the risks and benefits.'

Dr Greg Rogers, a GP with a special interest in epilepsy in Margate, Kent, and a member of the Primary Care Neurology Society's executive committee, said: 'I do think it's a problem in this day and age when there is pressure to switch to generics.

'When you have somebody stable, if you give them a different brand, it has the potential to increase side-effects and even lead to loss of seizure control.'

A survey by the charity Epilepsy Action last year found that a third of patients had been given a different version or brand of their usual anti-epileptic drug, and of those nearly a quarter had had an increase in seizures as a result.

A spokeswoman for Epilepsy Action said: 'We think it's a very serious issue in the UK. We are very concerned about the practice and think it's an important issue.'

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