home >> fact sheets >> Sodium-Valproate

(So-dee-um Val-pro-ate)

This information is not a replacement of full discussions of risks and benefits with your doctor

Other names: Epilim.

Principal Uses: is a mood stabiliser and an anticonvulsant. Used to treat mood disorders, especially Bipolar Affective disorder. It is also used to treat epilepsy.

Cost: Fully subsidised (ie cost of a script only)

Dose: Usually start at 200-400mg although if someone is acutely manic the starting dose might be high. It is usually given twice daily in the morning and at night.

How it works: Mechanism of action in mood disorders not fully understood.

Side Effects: Often minimal and dose-dependent. Initially there can be a mild tremor and some nausea. Weight gain with long term treatment can be a problem. Valproate can also cause a reversible lowering of the blood platelet count. Hair thinning and hair loss is a less common side effect and is reversible on stopping or can be counteracted by vitamin supplementation. Sedation and changes in liver functioning are both fairly rare side effects. There have been reports of menstrual disturbances and polycystic ovaries in young women receiving valproate treatment.

Use in Pregnancy: Category D
Much of the data for the use of this medication comes from its use in the treatment of epilepsy. What is clear from these studies is that the use of Sodium Valproate in pregnancy (particularly in the first trimester) is associated with an increase in birth abnormalities, particularly when the dose is more than 1,000mg per day. The risk is also increased when used in combination with other anti-epileptic drugs. There is emerging evidence that that the use of sodium valproate during pregnancy may be associated with longer term effects on the infant.

Category D indicates that there is positive evidence of human foetal risk, but the benefits from use in pregnant women may be acceptable despite the risk (e.g., if the drug is needed in a life-threatening situation or for a serious disease for which safer drugs cannot be used or are ineffective).

It is usually recommended that women in whom pregnancy is a possibility and who are taking sodium valproate, should take 5mg of folic acid daily. This is thought this may reduce the risk of neural tube defects.

Use in Breastfeeding: Category L2
Studies have shown that the amount of sodium valproate transferring to the infant in breast milk is very low. Some, however recommended that the infantís liver functions and platelets are monitored.

Category L2 refers to a medication which has been studied in a limited number of breast feeding women without an increase in adverse effects in the infant. And/or, the evidence of a demonstrated risk which is likely to follow use of this medication in a breast feeding woman is remote.

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