30 Nov 2020

GPs tell inquest they were unaware Pharmac changed their patients' epilepsy drugs

5:58 pm on 30 November 2020

Two GPs caring for patients who died after switching brands of an epilepsy drug say they were not aware of the Pharmac brand switch when they prescribed the drug for their patients.

Judge Marshall at the Auckland District Court

Judge Marshall at the Auckland District Court Photo: RNZ / Claire Eastham-Farrelly

The GPs were giving evidence at an inquest which opened today into the role the Pharmac brand switch had on the deaths of six people, who died after changing brands of an anti-epileptic drug called lamotrigine.

Gary Loye was the first witness at the inquest held at the Auckland District Court and recalled the day in February this year that his daughter Krystle Loye died at the age of 35.

"I called out, 'call an ambulance please Krystle is not breathing'," he said, after finding her unresponsive in her bed. "I knew by then she was gone."

Krystle had been on the Lamictal brand of lamotrigine for 10 years and for the last couple of years had been largely seizure free.

Gary told the inquest before Chief Coroner Judge Deborah Marshall that he was given very little information about why Pharmac was changing people over to a generic form of lamotrigine called Logem.

He recalled asking his daughter's GP about it.

"I asked why the change was being made and he said they stopped using the other one because of the pricing and this new brand was cheaper."

Barrister Todd Simmonds at the Auckland District Court during Gary Loye's evidence to the court.

Barrister Todd Simmonds at the Auckland District Court during Gary Loye's evidence to the court Photo: RNZ / Claire Eastham-Farrelly

More than 10,000 people with epilepsy were forced to switch brands of lamotrigine when Pharmac decided to fund only the generic form of the drug, Logem manufactured by Mylan.

Pharmac made the move to save $30 million over five years and free up the money to spend on other drugs, but they did so knowing that Medsafe strongly opposed the move, saying it went against international best practice and posed a safety risk.

Dr David Sharples was Krystle's GP for about 17 years. He said today the brand switch had gone ahead without him even knowing about it.

"To the best of my recollection I became aware of the planned change at some stage in early 2020."

At that point at least six people had died and the Chief Coroner had already decided to launch her inquiry.

Sharples also said he did not read any of the information Pharmac produced about the brand change.

He said that as a GP he was aware Pharmac often switched patients over to generic medicines but in hindsight he accepted that epilepsy was one where particular care was needed.

"Retrospect allows us to see this was significant for a number of reasons and on reflection, changes to epileptic medication have possibly more relevance than others."

But was it the drug switch that actually caused Krystle's death? Not according to neurologist Elizabeth Walker. In a report to the coroner she said it was unlikely to have been a contributing factor as Krystle was switched over to Logem five months before her death.

Among the other people who died after switching brands of epilepsy medicine was William Oliver who was 26-years-old when he had a seizure in the back of his car on 12 August, 2019.

Again, his GP Dr Joshua Tang was not aware of the Pharmac brand switch.

"I think I was aware of the brand switch when I saw Mr Oliver's death in the newspaper and the media - that is when I was first alerted to it."

He said if he had known about it he would have asked for Oliver to stay on his original brand of lamotrigine.

Walker said in a report to the coroner that it was unlikely the brand change had any relevance to Oliver's death because it occurred four months prior to his death.

She did however say the brand switch could not be ruled out as a factor in one of the other five deaths.

Medicine safety watchdog Medsafe opposed the brand switch, saying lamotrigine should be prescribed by brand because its effects on seizure control were so sensitive that small differences in the dose could have significant impacts.

Pharmac said the Logem brand of lamotrigine was widely used internationally and was entirely safe. The drug buyer stressed that if people were using the drug today they should not stop taking it.

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