Many pregnancies are unplanned, and the choice of antiseizure drug made years earlier often determines the exposure. Switching during pregnancy risks seizures; the time to choose is before.
- Ask every woman who could become pregnant about plans at the first prescription and each review
- Prefer lamotrigine or levetiracetam where they suit the epilepsy type
- Avoid valproate unless no alternative works, with documented counselling
- Prescribe folic acid to all women of childbearing potential on antiseizure drugs
- Use the lowest effective dose and a single drug where seizure control allows
Why it matters
The drug choice that determines fetal exposure is usually made long before pregnancy.
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