A Field Survey of Available Anti-Epileptic Drugs (AEDs) in Lagos - The Commercial Hub of Nigeria: Success and Challenges

Abstract

Background: Access to anti-epileptic drugs (AEDs) remains a major challenge in low- and middle-income countries, despite significant advancements in epilepsy therapy. Availability of both older and newer AEDs varies widely across regions, and limited access contributes to poor seizure control and increased morbidity. This study assessed the availability of AEDs across community and hospital-affiliated pharmacies in Lagos, Nigeria’s commercial hub. Methods: A descriptive cross-sectional survey was conducted among 50 pharmacies across Lagos Mainland and Lagos Island using a structured, self-administered questionnaire. Twenty-eight AEDs were evaluated. Availability was categorized as “Available” or “Not Available,” and pharmacies provided reasons for non-availability. Ethical approval and informed consent were obtained prior to data collection. Results: Among the 28 AEDs surveyed, 4 (14.3%)—retigabine, rufinamide, cenobamate, and stiripentol—were completely unavailable in all pharmacies. Older AEDs demonstrated the highest availability: carbamazepine (96.0%), pregabalin (98.0%), and sodium valproate (90.0%). In contrast, newer and third-generation AEDs such as brivaracetam, lacosamide, and eslicarbazepine were available in only 1% of pharmacies. Key reasons for non-availability included low demand, high cost, lack of importation, and limited pharmacy familiarity. Conclusions: AED availability in Lagos is heavily skewed toward older, first-line agents. As a result, most patients with epilepsy continue to rely predominantly on older antiepileptic drugs, with limited access to newer therapies due to cost and availability constraints. Newer and third-generation AEDs remain largely inaccessible, limiting therapeutic options for patients with refractory epilepsy. Addressing supply, affordability, and policy barriers is essential to improving epilepsy care in Nigeria.