Pharmac warned of epilepsy drug dangers

WELLINGTON: Pharmac knew there were clinical reasons some epilepsy patients would not tolerate a change to their medicines. But the drug buying agency went ahead with a switch that forced more than 10,000 people to change brands of the antiepileptic drug lamotrigine anyway.

That admission was contained in evidence presented by Pharmac yesterday at the Chief Coroner’s Inquest into whether the brand switch had any role in the deaths of six people, who died after changing epilepsy medication.

‘‘Pharmac staff were conscious when negotiating this agreement that there would be some patients who, for clinical reasons, would not be able to change brands of lamotrigine,’’ Pharmac director of operations manager Lisa Williams said.

She said that was why Pharmac’s agreement to allow the generic drug Logem to be the sole form of publicly funded lamotrigine provided for a ‘‘specified number of patients’’ to remain on their original brand of medicine.

Pharmac’s specialist neurological committee said in 2019 that the number of patients who would not tolerate the brand switch ‘‘would likely be low — less than 100’’.

Ms Williams said Pharmac aimed to save $30 million over five years with the switch, but had been cautious about the change because previous advice from its Pharmacology and Therapeutic Advisory Committee (PTAC), had warned against it.

‘‘PTAC had historically given advice cautioning against changing patients stabilised on one brand of lamotrigine in 2007 and against brand changes for antiepileptic drugs more generally in 2009, 2010, 2012 and 2013.’’

Because of that, Ms Williams said Pharmac was conscious of getting sound clinical advice before making the brand switch.

In 2019, Pharmac received assurance from its specialist neurological committee that it would be safe to make the brand switch.

Ms Williams said Pharmac had then gone to significant lengths to help patients switch brands before the move was fully implemented on October 1, 2019.

This included a fivemonth transition period, rather than the normal three, and offering patients a free GP visit if they needed it.

Pharmac said it distributed information about the change widely, including on its own website and by engaging with interest groups such as Epilepsy New Zealand.

The inquest also heard from the UKbased Jane Hanna OBE, an international expert with 25 years’ experience in tackling epilepsy deaths.

Ms Hanna told the inquest that changing brands of medication was a known risk factor in epilepsy fatalities. — RNZ