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Migraine prophylaxis pregnancy — GPhC CRA MCQ

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HardCNS TherapeuticsMigraine prophylaxis pregnancyGPhC CRA

A 28-year-old woman uses topiramate 50 mg twice daily for migraine prevention. She has a negative pregnancy test but uses a combined oral contraceptive and has not completed a risk-awareness form. What is the most appropriate action before the next supply?

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Correct answer: E — Withhold routine supply and arrange prescriber review of programme requirements

For any indication, women of childbearing potential must meet the topiramate Pregnancy Prevention Programme requirements: effective contraception, pregnancy exclusion, documented understanding of fetal risks and at least annual review. Topiramate may also affect some hormonal contraceptives. A negative test alone is insufficient; abrupt unsupervised cessation is inappropriate, but routine dispensing without resolving the missing safeguards is unsafe.

Reference: MHRA Drug Safety Update, Topiramate Pregnancy Prevention Programme: https://www.gov.uk/drug-safety-update/topiramate-topamax-introduction-of-new-safety-measures-including-a-pregnancy-prevention-programme