title: Substitution of anticonvulsant drugs.
abstract: Changing from branded drugs to generic alternatives, or between different generic formulations, is common practice aiming at reducing health care costs. It has been suggested that antiepileptic drugs (AEDs) should be exempt from substitution because of the potential negative consequences of adverse events and breakthrough seizures. Controlled data are lacking on the risk of substitution. However, retrospective data from large medical claims databases suggest that switching might be associated with increased use of AED and non-AED medications, and health care resources (including hospitalization). In addition, some anecdotal evidence from patients and health care providers' surveys suggest a potentially negative impact of substitution. Well-controlled data are needed to assess the real risk associated with substitution, allowing health care professionals involved in the care of patients with epilepsy to make informed decisions. This paper reviews currently available literature, based on which the authors suggest that the decision to substitute should be made on an individual basis by the physician and an informed patient. Unendorsed or undisclosed substitution at the pharmacy level should be discouraged.
authors.affiliation: Epilepsy Center, Kehl-Kork, Germany;
authors.forename: Bernhard J
authors.initials: BJ
authors.lastname: Steinhoff
authors.forename: Uwe
authors.initials: U
authors.lastname: Runge
authors.forename: Otto W
authors.initials: OW
authors.lastname: Witte
authors.forename: Hermann
authors.initials: H
authors.lastname: Stefan
authors.forename: Andreas
authors.initials: A
authors.lastname: Hufnagel
authors.forename: Thomas
authors.initials: T
authors.lastname: Mayer
authors.forename: Günter
authors.initials: G
authors.lastname: Krämer
references.citation: Epilepsy Behav. 2008 Jul;13(1):127-30
references.pmid: 18406211
references.citation: Can J Neurol Sci. 2000 Feb;27(1):37-43
references.pmid: 10676586
references.citation: Neurology. 2004 Oct 26;63(8):1494-6
references.pmid: 15505173
references.citation: Epilepsia. 2007 Mar;48(3):464-9
references.pmid: 17346246
references.citation: Epilepsy Behav. 2005 Aug;7(1):98-105
references.pmid: 15961350
references.citation: Pharm Res. 1992 Dec;9(12):1612-6
references.pmid: 1488405
references.citation: Epilepsia. 1996;37 Suppl 2:S1-S3
references.pmid: 8641240
references.citation: Seizure. 2006 Apr;15(3):165-76
references.pmid: 16504545
references.citation: Epilepsy Behav. 2004 Dec;5(6):995-8
references.pmid: 15582850
references.citation: Ann Pharmacother. 1992 Jun;26(6):775-7
references.pmid: 1611158
references.citation: Epilepsy Behav. 2008 Nov;13(4):693-9
references.pmid: 18589000
references.citation: Epilepsia. 2006;47 Suppl 5:16-20
references.pmid: 17239100
references.citation: Clin Ther. 2007 Feb;29(2):334-41
references.pmid: 17472825
references.citation: J Clin Pharmacol. 1986 May-Jun;26(5):309-16
references.pmid: 3700686
references.citation: Epilepsy Behav. 2002 Dec;3(6):522-525
references.pmid: 12609245
references.citation: Ann Pharmacother. 1997 May;31(5):548-52
references.pmid: 9161646
references.citation: Neurology. 2008 May 27;70(22 Pt 2):2179-86
references.pmid: 18505997
references.citation: Epilepsia. 1995 Dec;36(12):1187-94
references.pmid: 7489695
references.citation: Neurology. 1987 Dec;37(12):1885
references.pmid: 3120036
references.citation: Neurology. 1990 Nov;40(11):1641-3
references.pmid: 2234417
references.citation: Seizure. 1996 Mar;5(1):1-5
references.pmid: 8777549
references.citation: Rev Neurol (Paris). 2007 Apr;163(4):455-61
references.pmid: 17452947
references.citation: Epilepsia. 2005;46 Suppl 11:54-61
references.pmid: 16393182
references.citation: Acta Neurol Scand. 2005 May;111(5):291-300
references.pmid: 15819708
references.citation: JAMA. 1987 Sep 4;258(9):1216-7
references.pmid: 3626006
references.citation: Neurology. 2008 Aug 12;71(7):525-30
references.pmid: 18695164
references.citation: Epilepsia. 2003;44 Suppl 6:1-88
references.pmid: 12919341
references.citation: Br J Clin Pract. 1990 Jul;44(7):270-3
references.pmid: 2206824
references.citation: Epilepsy Res. 2002 Nov;52(1):61-9
references.pmid: 12445961
references.citation: Neurology. 1993 Dec;43(12):2696-7
references.pmid: 8255480
references.citation: Pharm Res. 1998 Nov;15(11):1787-91
references.pmid: 9834004
references.citation: Epilepsia. 2009 Mar;50(3):493-500
references.pmid: 18616554
references.citation: Epileptic Disord. 2007 Dec;9(4):465-6
references.pmid: 18055310
references.citation: Neurology. 2007 Apr 17;68(16):1249-50
references.pmid: 17438213
references.citation: Epilepsy Behav. 2009 Jan;14(1):113-7
references.pmid: 18768168
references.citation: J Neurol Neurosurg Psychiatry. 1992 Aug;55(8):688-91
references.pmid: 1527539
references.citation: Lancet Neurol. 2007 May;6(5):465-8
references.pmid: 17434101