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The prescribing of generic antiepileptic drugs (AEDs) continues to generate much debate and much confusion.1–5 The fear is that seizures may recur with a fall in serum concentration or that toxicity may occur with a rise in serum concentration when the patient takes an AED from a different source. Such problems might arise when a branded drug is switched to a generic, when a generic is switched to a branded drug, or, indeed, when one generic is switched to another. These issues have been discussed extensively in the literature; the details of the arguments will not be repeated here. Worthwhile recommendations have been made. For example, the Italian League Against Epilepsy working group6 concluded that generic drugs meeting current regulatory criteria for bioequivalence represent a reasonable value choice in the management of epilepsy, particularly with patients for whom therapy is being initiated; they acknowledged, however, that a modest change in plasma drug levels could occur with drug substitution and this could, in rare cases, lead to seizure breakthrough. Generic substitution or changes between different generics were not recommended in patients who had achieved seizure remission. This recommendation does not account for those instances in which the choice of generic is not controlled by the physician or the patient.
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