UK Clinical Pharmacy Association


Issues for surgery

Precipitation of rebound seizures or status epilepticus if omitted.

Advice in the perioperative period

Elective and emergency surgery


Patients should be advised to take their regular medications on the day of surgery.

Abrupt withdrawal of any anticonvulsant drug should be avoided.

Confirm with the patient if they need to be maintained on a specific manufacturer’s product (see Further information).

Post-operative advice

Regular dosing of the patient’s usual oral medication should be re-established as early as possible post-operatively.

If patients are unable to take their regular oral medication post-operatively, consider using the oral powder sachets via the rectal route [unlicensed use]. The rectal dose and frequency should be the same as the established oral dose. Alternatively, seek the advice of a neurologist to determine an appropriate medication, dose, route and frequency.

Interactions with common anaesthetic agents


For general information regarding the use of anaesthetic agents in patients with epilepsy see Antiepileptics overview.

Interactions with other common medicines used in the perioperative period


For general information regarding the use of antiemetics in patients with epilepsy see Antiepileptics overview.

Further information

MHRA/CHM Advice: Antiepileptic Drugs: updated advice on switching between different manufacturer’s products (November 2017)

Vigabatrin is a category 3 antiepileptic, hence it is usually unnecessary to ensure that patients are maintained on a specific manufacturer’s product unless there are specific concerns such as patient anxiety, and risk of confusion or dosing errors. For more information see Antiepileptics overview.

Liver function tests (LFTs)

Vigabatrin may lead to a decrease in measured plasma activity of alanine aminotransferase (ALT) and to a lesser extent, aspartate aminotransferase (AST). The magnitude of suppression for ALT has been reported to vary between 30% and 100%. Bear this in mind if it is necessary to check LFTs pre-operatively as these liver tests may be quantitatively unreliable in patients taking vigabatrin.


Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press [Accessed 30th June 2019]

Perks A, Cheema S, Mohanraj R. Anaesthesia and epilepsy. BJA: British Journal of Anaesthesia. 2012; 108(4):562-571

Carter EL, Adapa RM. Adult epilepsy and anaesthesia. BJA Education. 2015; 15(3):111-117

Baxter K, Preston CL (eds), Stockley’s Drug Interactions (online) London: Pharmaceutical Press. [Accessed on 20th July 2019]

Vigabatrin. In: Brayfield A (Ed), Martindale: The Complete Drug Reference. London: The Royal Pharmaceutical Society of Great Britain. [Accessed 20th July 2019]

Summary of Product Characteristics – Sabril® (vigabatrin) 500mg film-coated tablets. SANOFI. Accessed via 20/07/2019 [date of revision of the text November 2018]