14th February 2025

Sodium valproate

Valproate is licensed for acute mania and is also commonly used (unlicensed) for long-term prophylaxis.

It should not be offered to females of childbearing age unless other options are inappropriate, ineffective or not tolerated and a pregnancy prevention programme is in place.

Adverse effects of valproate

Dose-related adverse effects include GI upset, deranged LFTs, tremor and sedation. Leucopaenia, thrombocytopaenia, alopecia, weight gain, and pancreatitis are non dose-related adverse effects.

Like lithium, it has a narrow therapeutic window and thus toxicity can occur with high plasma levels; hypersomnolence, atrioventricular block, coma and death are seen.

Valproate monitoring

FBC, LFTs and BMI should be checked prior to starting then 6 monthly. An ECG should be done at initiation.

References

• Semple D, Smyth R. Oxford handbook of psychiatry. Oxford; New York: Oxford University Press; 2019
• World Health Organization. ICD-11 for Mortality and Morbidity Statistics [Internet]. World Health Organization; 2019 [cited 2022 Mar 3]. Available from: https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/1707067746
• Selvaraj S. Bipolar disorder in adults [Internet]. BMJ Best Practice; 2020 [cited 2022 Mar 7]. Available from: https://bestpractice.bmj.com/topics/en-gb/488
• National Institute for Health and Care Excellence. Bipolar disorder [Internet]. NICE; 2020 [cited 2022 Mar 7]. Available from: https://www.nice.org.uk/guidance/cg185
• Joint Formulary Committee. British National Formulary. Lithium Carbonate [Internet]. London: British Medical Association and Royal Pharmaceutical Society of Great Britain; 2020 [cited 2022 Mar 9]. Available from: https://bnf.nice.org.uk/drug/lithium-carbonate.html
• Joint Formulary Committee. British National Formulary. Sodium Valproate [Internet]. London: British Medical Association and Royal Pharmaceutical Society of Great Britain; 2019 [cited 2022 Mar 10]. Available from: https://bnf.nice.org.uk/drug/sodium-valproate.html