Epilepsy Patients Want Notice About Medication Switch

HARTFORD (AP) — For the past nine years, doctors have tried 16 different drugs, in various combinations, to control Shelby Paul’s epileptic seizures.

While none have yet worked, her father, Dwayne Paul, holds out hope that something will be found to help his 17-year-old daughter. But the Milford man worries in the meantime that a pharmacist will switch one of Shelby’s generic drugs without his knowledge.

“We keep very detailed records of the medications she’s on,” Mr Paul said.

Throwing different drugs into the mix — even generics — could make it more difficult for the family to finally find the right medication for Shelby, he said in a recent interview.

“The active ingredient [in generic drugs] is the same, but there’s what you call fillers that make up the rest of the medication, and those fillers can vary very greatly among manufacturers,” he said.

Mr Paul traveled to the state Capitol one recent afternoon to testify in favor of a bill before the Public Health Committee that would prohibit a pharmacist from substituting an antiepileptic drug or formulation without first obtaining consent from the patient and/or the prescribing physician.

There is already a law that allows a physician to specifically request that a pharmacist prescribe a brand-name drug instead of a generic. Linda Wallace, executive director of the Epilepsy Foundation of Connecticut, said this bill would essentially prevent switching from one generic drug to another without permission.

“Because people with epilepsy are unique, they need to have a certain amount of medication in their bloodstream to control their seizures,” Ms Wallace said, adding that any little change could pose a problem for patients. Too much of an ingredient can lead to toxicity problems while too little can lead to seizures, she said.

Epilepsy is a neurological condition that occasionally produces brief disturbances in the normal electrical functions of the brain, according to the Epilepsy Foundation.

Margherita R. Giuliano, executive vice president of the Connecticut Pharmacists Association, said her group questions whether the bill is necessary. She points to an October 2007 report from the US Food and Drug Administration that said generic drugs are identical to their brand-name counterparts and are safe and effective.

“There’s no scientific evidence,” she said, referring to the claims that there is a difference with generic drugs. “I’m not going to doubt what happens in practice, but there are so many other things that can affect a seizure threshold.”

Also, Ms Giuliano said requiring a pharmacist to get obtain consent before prescribing a drug could become a burden for pharmacies.

Instead, the pharmacists are offering up a compromise this session that would allow a doctor to send an “expanded prescription” to a pharmacy, spelling out which generic drug should be given to a patient.

“If you’re a prescriber and you need someone to help manage your patient, we can do that for you through a protocol,” she said. “Don’t carve it out as a special group, because it’s not necessary.”