Alternatives to Epidiolex If You Can't Fill Your Prescription

Epidiolex (cannabidiol) is the first and only FDA-approved prescription CBD medication for seizures associated with Lennox-Gastaut syndrome (LGS), Dravet syndrome, and tuberous sclerosis complex (TSC). But specialty pharmacy requirements, insurance prior authorization hurdles, and high costs can make accessing it challenging. If you or a family member cannot get Epidiolex filled, there are other FDA-approved and widely used options your neurologist may consider. Always discuss medication changes with your prescribing neurologist or epileptologist before making any switch.

Important: Talk to Your Neurologist First

LGS, Dravet syndrome, and TSC are complex, treatment-resistant epilepsies. Seizure control in these conditions often requires careful selection of medications, since some antiseizure drugs can actually worsen certain seizure types — particularly in Dravet syndrome. Never stop Epidiolex or add a new medication without guidance from your neurology team.

1. Fintepla (Fenfluramine) — For Dravet Syndrome and LGS

Fintepla (fenfluramine) is FDA-approved for seizures associated with Dravet syndrome (2020) and Lennox-Gastaut syndrome (2022) in patients 2 years of age and older. It works by targeting the serotonin system, specifically 5-HT2B and 5-HT2C receptors. Clinical experts often describe fenfluramine as a game-changer for Dravet syndrome, noting it tends to show strong efficacy.

Important considerations: Fintepla is a Schedule V controlled substance and requires a REMS (Risk Evaluation and Mitigation Strategy) program because of cardiac risks — specifically valvular heart disease and pulmonary arterial hypertension. Patients must undergo echocardiograms before and during treatment. It should not be used with serotonergic agents or certain other medications.

2. Diacomit (Stiripentol) — For Dravet Syndrome

Diacomit (stiripentol) is FDA-approved as adjunctive therapy for Dravet syndrome in patients 6 months of age and older who are also taking clobazam. It works primarily through GABAergic mechanisms and by inhibiting cytochrome P450 enzymes, which increases plasma levels of other antiseizure medications like clobazam. It is also a specialty medication and requires a specific combination with clobazam to be used.

3. Clobazam (Onfi, Sympazan) — For LGS and Dravet Syndrome

Clobazam is a benzodiazepine that is FDA-approved for adjunctive treatment of seizures associated with LGS in patients 2 years of age and older. It is one of the most commonly used first-line or add-on therapies in both LGS and Dravet syndrome. It is available as tablets (Onfi) and oral film strips (Sympazan). It is a Schedule IV controlled substance and generics are available, making it more accessible and affordable than Epidiolex.

Note: Clobazam is often used alongside Epidiolex, not instead of it. However, if Epidiolex is temporarily unavailable, your neurologist may adjust your clobazam dose as part of a bridge plan.

4. Valproic Acid / Valproate (Depakote, Depakene) — Broad-Spectrum First-Line

Valproic acid is a widely used broad-spectrum antiseizure medication and is considered a first-line treatment for both LGS and Dravet syndrome. It enhances GABA activity and has effects on sodium channels and potassium channels. Generic versions are widely available and affordable. However, it carries risks of hepatotoxicity (especially in young children under 2), and its use with Epidiolex significantly increases the risk of liver enzyme elevations.

5. Lamotrigine (Lamictal) — For LGS

Lamotrigine (Lamictal) is FDA-approved for adjunctive treatment of seizures associated with LGS in patients 2 years and older. It is a first-line option for LGS and works by blocking voltage-sensitive sodium channels. Generic lamotrigine is widely available and much more affordable than Epidiolex. However, lamotrigine must be titrated very slowly to reduce the risk of serious rash (Stevens-Johnson syndrome), and it is generally avoided in Dravet syndrome as it may worsen seizures.

6. Rufinamide (Banzel) — Specifically for LGS

Rufinamide (Banzel) is FDA-approved specifically for adjunctive treatment of LGS in patients 1 year of age and older. It is a triazole derivative that modulates sodium channel activity. It can be particularly effective for tonic and atonic (drop) seizures, which are hallmarks of LGS. It is a specialty medication but may be easier to obtain than Epidiolex in some insurance situations.

Medications to Avoid in Dravet Syndrome

This is critical: patients with Dravet syndrome must avoid sodium channel-blocking antiseizure medications, which can dramatically worsen seizures. These include:

Carbamazepine (Tegretol)

Oxcarbazepine (Trileptal)

Lamotrigine (Lamictal)

Phenytoin (Dilantin)

Vigabatrin (Sabril)

What to Do If You Can't Get Epidiolex Right Now

If you're having trouble filling Epidiolex, your first step should be exhausting the access tools available — before switching medications. Call JazzCares (1-833-426-4243) to enroll in the Quick Start Program for up to 60 days of free medication while insurance approval is pending. Use medfinder to identify specialty pharmacies near you that have Epidiolex and can fill your prescription.

If you've tried these options and still need alternatives, have a frank conversation with your neurologist about what makes sense for your specific seizure profile. For more on accessing Epidiolex, read our guide on why Epidiolex is hard to find and visit medfinder.com to start searching.