Medication Switching

While most patients can safely switch their medications among different formulations of the same antiepileptic medication, the Epilepsy Foundation recommends that consent must be obtained from the individual with epilepsy and their physician before any such substitutions are made – to avoid potentially life-threatening seizures.

Members of the epilepsy community have for years reported experiencing seizures and other harmful side effects after switching from one version of an antiepileptic drug (AED) to another, whether the switch was brand-to-generic, generic-to-brand, or generic-to-generic. By law, the amount of medication delivered by one AED may differ from the amount delivered by another AED that the Food and Drug Administration (FDA) deems "equivalent," and it may deliver the medication at a different rate. There is growing evidence that these variations, however slight, can mean the difference between controlled epilepsy and breakthrough seizures or other negative consequences.

Patients today are most typically switched from brand-name drugs to generics, or from one generic drug to another, for a single, non-clinical reason: pressure to reduce costs. In most states, unless a physician explicitly writes "dispense as written" or "no substitution," pharmacists can switch a patient to a lower-cost generic drug without the consent or knowledge of either the patient or the physician.

The Epilepsy Foundation appreciates that cost-control is a worthy goal and, in general, it enthusiastically supports providing patients with greater access to generic medications. The Foundation is committed to the welfare of people with epilepsy and their families, and the high cost of many name-brand medications is a particularly significant issue for people with epilepsy, many of whom will take medication on a daily basis for the remainder of their lives. The Foundation welcomes the opportunity that generic medications present to lower the overall costs of delivering effective healthcare to individuals and society.

But the Foundation believes equally that short-sighted cost considerations should never be allowed to trump efficacy or take precedence over patient welfare. Indeed, if a patient is switched off of a well-functioning drug to avoid costs, the direct economic consequences borne by society if the cheaper drug fails—whether incurred in the form of increased ambulance rides and emergency-room admissions, greater numbers of in-patient doctor visits, or lost worker productivity will quickly eliminate any short-term savings occasioned by the switch. Meanwhile, the concurrent human costs borne by patients and their families can be immeasurable.


Generic drugs can save you money, but not when switching among different versions causes seizures or side effects

The Epilepsy Foundation actively supports the increased use of generic medications as a way to save money in healthcare. Because medications are a major cost of epilepsy, the availability of less expensive versions of brand name medicine can be very good news for people with epilepsy. Medication switching is a major concern because seizures are serious events that can have considerable cost to one's health, well-being, and pocketbook – and can even be life threatening for the person experiencing the seizure, or because that person accidentally injures someone else during the seizure.

The Foundation has written to the major insurance companies sharing the data on switching and requesting that, given the elevated risk, companies not require patients on brand AEDs to switch and to eliminate any cost differential between brand and generic AEDs for people with epilepsy.

Click here for more information on what you can do to ensure your medication is covered and to learn more about the Epilepsy Foundation's outreach and education to insurance companies about medication switching.