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Discussion about an upcoming brand change is also useful to prepare patients for the change that will need to occur when their current brand is no longer funded.

When a different brand is dispensed, pharmacists can show the patient what their new medicine looks like and emphasise that the active ingredient remains the same. The three currently funded brands of lamotrigine have a similar appearance, size and flavouring, with tablet shape being the main difference between brands (Table 3).

Evidence suggests that changes in the appearance of a medicine may influence adherence,8, 31 therefore this is a crucial time to ensure that patients are aware of the brand change and to address any potential issues.

Tablet size increases with strength. The tablet sizes for each strength are similar between brands. If clinical symptoms and signs have emerged since the brand change, consider whether they could be caused by small differences in absorption of medicine with the new brand, or whether other factors could explain the occurrence, e. If these symptoms occur, consider requesting a serum lamotrigine level and discuss with a neurologist, paediatrician or psychiatrist as appropriate. The Neurological and Mental Health Subcommittees of PTAC considered whether monitoring serum levels of lamotrigine would aid in clinical management during a brand change, however, they concluded that based on available evidence this would be of little benefit as monitoring is generally used to check for adherence, possible toxicity or during pregnancy.

If patients are having difficulty after being changed to Logem and require an additional appointment to discuss concerns, clinicians can invoice PHARMAC for the General Practitioner co-payment fee (i.

This could include a patient who clinicians believe would be unable to manage a change in brand, e. Expert reviewers do not write the articles and are not responsible for the final content.

We have now added the ability to add replies to a comment. PHARMAC have not been informed of any significant clinical impacts for these patients when they changed brands, and reports to the Centre for Adverse Reactions Monitoring (CARM) have not identified ongoing problems from brand changes. Carbamazepine Phenobarbital Phenytoin Primidone Category 2 Antiepileptic medicines which do not clearly fit into either of the other two categories based on evidence available at the time of assessment Clobazam Clonazepam Lamotrigine Sodium valproate Topiramate Category 3 Antiepileptic medicines where the potential for clinically relevant differences between brands to exist was low Ethosuximide Gabapentin Lacosamide Levetiracetam Pregabalin Vigabatrin Changing patients to another brand of lamotrigine Discuss the brand change and address questions and concerns Brand changes for antiepileptic medicines can be a cause of apprehension or concern for parents or caregivers.

Patients and caregivers can be reassured that the evidence has been thoroughly reviewed and concerns discussed extensively by the PTAC Subcommittees who concluded that there was no pharmacological reason to suggest there would be a clinical problem from changing brands of lamotrigine for the majority of patients with epilepsy or mental health conditions.

Some patients or caregivers may worry that the formulation they are receiving will not be as safe or effective as their current brand, e. Is it ok for my child to change brands.

Can I combine brands. Will I notice any difference when I change brands. One of the key dilemmas when changing patients with epilepsy to another brand of medicine is that if seizures occur it is difficult to determine whether a change in brand is the cause of their altered seizure control. Will the brand change affect my driver licence. Patients may notice a difference in the shape of their tablets When a different brand is dispensed, pharmacists can show the patient what their new medicine looks like and emphasise that the active ingredient remains the same.

The reverse side has a line marked on it. Tablet appearance White to off-white Round with a flat face White to off-white, rounded edges with a raised centre White to off-white Shield-shaped 25 mg 50 mg 100 mg Tablet size Tablet size increases with strength.

Symptoms which could indicate that patients are absorbing an increased dose of lamotrigine include:7 Headache Nausea Tremor Dizziness Irritability Blurred vision or visual disturbances If these symptoms occur, consider requesting a serum lamotrigine level and discuss with a neurologist, paediatrician or psychiatrist as appropriate.

Routine monitoring of serum levels is not necessary The Neurological and Mental Health Subcommittees of PTAC considered whether monitoring serum levels of lamotrigine would aid in clinical management during a brand change, however, they concluded that based on available evidence this would be of little benefit as monitoring is generally used to check for adherence, possible toxicity or during pregnancy.

If needed, funding to cover the cost of a follow-up appointment is available If patients are having difficulty after being changed to Logem and require an additional appointment to discuss concerns, clinicians can invoice PHARMAC for the General Practitioner co-payment fee (i.

References National Institutes for Health and Care Excellence (NICE). Epilepsies: diagnosis and management. National Institutes for Health and Care Excellence (NICE). Bipolar disorder: assessment and management. Decision to move to one funded brand of lamotrigine (Logem). Record of the joint Neurological and Mental Health Subcommittee meeting held on 7 February 2019.