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Sodium valproate inhibits the breakdown and reuptake of the inhibitory neurotransmitter gamma aminobutyric acid (GABA).
This agent is useful in the primary generalised epilepsies, particularly petit mal. It is also useful in generalised tonic-clonic attacks, particularly those patients with a photosensitive EEG.
Sodium valproate is also useful in myoclonic epilepsy. It does not interfere
with the oestrogen component of the contraceptive pill, unlike carbamazepine
and the barbiturates.
Valproate is a possible treatment option for long term management in bipolar
NICE (1) suggest with respect to:
- when starting valproate, measure the person's weight or BMI and carry out
a full blood count and liver function tests
- people taking valproate, and their carers, should be advised how to recognise
the signs and symptoms of blood and liver disorders and to seek immediate
medical help if any of these develop. Stop valproate immediately if abnormal
liver function** or blood dyscrasia is detected
- prescribers should be aware of its interactions with other anticonvulsants
(particularly carbamazepine and lamotrigine) and with olanzapine and smoking
The summary of product characteristics should be consulted before prescribing
- * in September 2014 semi-sodium valproate had a UK marketing authorisation
for this indication in people who have had mania that has responded to treatment
with semi-sodium valproate. Sodium valproate did not have a UK marketing authorisation
for this indication, although its use is common in UK clinical practice. The
prescriber should follow relevant professional guidance, taking full responsibility
for the decision. Informed consent should be obtained and documented
- ** although the absolute values of hepatic enzymes are a poor indicator
of the extent of hepatic damage, it is generally accepted that if these are
persistently elevated to over 3 times the upper normal limit, continuing to
rise or accompanied by clinical symptoms, the suspected drug should be withdrawn.
Raised hepatic enzymes of any magnitude accompanied by reduced albumin or
impaired clotting suggest severe liver disease
- valproate treatment must not be used in girls and women including in young
girls below the age of puberty, unless alternative treatments are not suitable
and unless the conditions of the pregnancy
prevention programme are met. Valproate must not be used in pregnant
- with respect to stopping valproate in bipolar disorder (1):
- if stopping valproate, reduce the dose gradually over at least 4 weeks
to minimise the risk of relapse
Last edited 08/2018