Abstracts

Rationale: Manufacturer changes of antiepileptic drugs may cause blood concentrations to change and breakthrough seizures or adverse effects to occur due to variability between medications. Loss of seizure control can have serious physical, mental, and social consequences for a patient. Concerns about effects of medication manufacturer changes have been discussed and documented within the epilepsy and neurology communities. Pharmacists also play an important role in care for patients with epilepsy, but little information is known about pharmacist knowledge and attitudes regarding antiepileptic medication changes. This survey was performed to evaluate the knowledge base, practices, and experiences of pharmacists in a retail setting regarding the changing of manufacturers with antiepileptic drugs.Methods: A cross-sectional survey of pharmacists working in retail or community pharmacies in the Cincinnati, Ohio area was performed. Subjects were given a 14 item paper survey with questions about basic knowledge, opinions and practices associated with switching antiepileptic medication manufacturers.Results: A total of 30 pharmacists completed the survey, with a mean (SD) of 15.6 (8.8) years in practice. Only one third of pharmacists surveyed reported receiving previous education about antiepileptic drug manufacturer changes. Most pharmacists (73%) have reservations when switching from brand to generic antiepileptic drugs, while 60% of pharmacists report reservations switching between generic antiepileptic drug manufacturers. Pharmacists reported greater concern for manufacturer changes with older antiepileptic medications, and in changes occurring in patients with refractory seizures, patients on multiple antiepileptic medications, or in children or the elderly. Most pharmacists (80%) reported trying to keep the same antiepileptic drug manufacturer in stock for patients. A majority (87%) of surveyed pharmacists inform their patients when a manufacturer has been changed, however only a minority (13%) report informing prescribers when a manufacturer has been changed. Only 37% of pharmacists knew the correct range the Food and Drug Administration uses for bioequivalence, while 63% thought the bioequivalence range was stricter. Of pharmacists surveyed, nearly a third (30%) were aware of patients that experienced breakthrough seizures or side effects associated with a manufacturer change.Conclusions: Most pharmacists have reservations when switching between manufacturers for AEDs; however there is a knowledge gap regarding FDA requirements for bioequivalence and the importance of communicating manufacturer changes with prescribers. This study highlights a need for education on these issues and the importance of communication between retail pharmacists, patients and epilepsy care providers.