FAQs for pharmacists

For pharmacists

What is the Charlie Card?
The Charlie Card is a patient advocacy tool developed by SUDEP Action and Henrietta Hastings to support individuals with epilepsy in accessing emergency medication. It highlights the legal framework under the Human Medicines Regulations 2012 that allows pharmacists to supply prescription-only medicines in an emergency. It was developed in response to the avoidable death of Charlie Marriage: Prevention of Future Deaths Report – Courts and Tribunals Judiciary.

Does the Charlie Card give the patient a legal right to their regular medication?
No. The card does not confer an automatic right. It provides information which supports the pharmacist’s discretion under Regulation 224, which allows emergency supply if certain conditions are met. The pharmacist must be satisfied that there is an immediate need and that the supply is safe and lawful. The Charlie Card helps to clarify that epilepsy is a cliff-edge condition and that continuity of epilepsy medication is an emergency.

What conditions must be met for emergency supply?

There are three central conditions set out by the regulation that the pharmacist must interview the person requesting the prescription and satisfy:

1.That there is an immediate need for the prescription-only medicine to be sold or supplied and that it is impracticable in the circumstances to obtain a prescription without undue delay. The Charlie Card helps to highlight an immediate need, where there is a risk of an epilepsy medication dose being missed.

2.That treatment with the prescription-only medicine has on a previous occasion been prescribed by a relevant prescriber for the person requesting it (here you may ask the patient to provide evidence of a prior prescription e.g. empty packaging, repeat slip, patient record).

3.That you can confirm the dose which in the circumstances it would be appropriate for that person to take.

The pharmacist’s discretion needs to be exercised under duty of care and normal professional principles will be relevant to the decision. Royal Pharmaceutical Guidelines are that the pharmacist should consider the medical consequences of not supplying a medicine in an emergency and if the pharmacist is unable to make an emergency supply of a medicine the pharmacist should advise the patient how to obtain essential medical care.

What if you do not have the specific brand or dose?

If the dose or formulation or the product is different from what the patient has been  prescribed, it may not be clinically appropriate or safe. This is especially true for epilepsy where substituting brands or doses may increase seizure risk.

See here for detailed information regarding specific anti-seizure medications and which risk category they fall in to if there are switches to different drug company products: Antiepileptic drugs: updated advice on switching between different manufacturers’ products – GOV.UK.

Is this regulation UK-wide?
Yes. The Human Medicines Regulations 2012 applies across England, Scotland, Wales, and Northern Ireland.

What should I do if I cannot supply the medicine?
If you are unable to supply the medicine, clearly explain the reason to the patient and document it. Encourage them to contact their prescriber or try another pharmacy. If the refusal is not based on stock availability, regulatory or clinical grounds, the patient may raise a concern or complaint.

How should I respond to a parent or carer presenting the card?
Treat the card as a prompt to assess the situation with urgency and empathy. People with epilepsy, parents and carers may be managing life-threatening conditions and need support. Use your professional judgement to determine whether an emergency supply is appropriate and safe.

What if I’m unsure about the legal basis or clinical safety?
Refer to Regulation 224 of the Human Medicines Regulations 2012 and consult your superintendent pharmacist or local NHS guidance. You can also contact SUDEP Action for further information or support.

What if the medication contains phenobarbital or phenobarbital sodium?

While phenobarbital based medications are generally excluded from the emergency prescription regulations, there is a specific exception where the medication is prescribed for epilepsy (under s225(4) of the Human Medicines Regulations Act 2012).

Do you have any other resources?

The QR code on the Charlie Card takes you to other resources that can specifically inform you and any professional of individual risks and why medicine is time-critical, e.g.

EpSMon app – SUDEP Action

SUDEP and Seizure Safety Checklist – SUDEP Action

Learning disability resources – SUDEP Action