Sodium valproate

Commonly called valproate. Sounds like 'val-PRO-ate'

Overview
Clinicians

Easy-to-read medicine information about sodium valproate – what it is, how to take sodium valproate safely and possible side effects.

Type of medicine	Also called
Belongs to a group of medicines known as anti-epileptic medicines (to prevent seizures)	Epilim®

What is valproate?

Valproate has many uses: treating epilepsy by preventing seizures, controlling some mood disorders such as bipolar disorder and preventing migraine headaches. Valproate works by blocking certain kinds of nerve activity. In New Zealand, valproate is available as:

Epilim liquid 200 mg in 5 mL
Epilim 100 mg tablets (white tablets)
Epilim EC 200 mg or 500 mg tablets (lilac tablets).

Dose

The dose of valproate will be different for different people.
Your doctor will start you on a low dose and increase your dose slowly over a few weeks.
It is usually taken 2 or 3 times a day.
Always take your valproate exactly as your doctor has told you. The pharmacy label on your medicine will tell you how much to take, how often to take it and any special instructions.

How to take valproate

Valproate is best taken with food.
Take your doses at the same times each day, to help you to remember to take it.
Valproate is available as a liquid or as tablets.

Formulation	How to take it
Epilim liquid	Measure the right amount using an oral syringe or medicine spoon. You can get these from your pharmacy. Do not use a kitchen spoon as it will not give you the right amount. Read more: Tips on how to give medicines to babies and children.
Epilim tablets (white tablets)	You can swallow these tablets with a glass of water, juice or milk, or you can crush them to make it easier to swallow. Crush the tablets and mix with a small amount of soft food such as yoghurt or a small drink. Swallow the food or drink straight away.
Epilim EC tablets (lilac tablets)	These are called enteric-coated (EC) tablets and are designed to prevent the medicine from upsetting the stomach. Do not crush or chew them, as this will destroy the coating and be more likely to cause side effects. Take these tablets with a glass of water, juice or milk.

If you forget to take your dose, take it as soon as you remember that day. But, if it is nearly time for your next dose, just take the next dose at the right time. Do not take double the dose.
Keep taking sodium valproate regularly every day (see tips to help you remember to take your medicines regularly). It may take a few weeks before you experience the full benefits of sodium valproate. Do not stop taking sodium valproate suddenly as this can cause problems; speak to your doctor or nurse before stopping.

Precautions – before starting valproate

Sex and pregnancy

If you are a sexually active female and are taking valproate, you should use 2 effective means of contraception (such as an IUD and condoms) to avoid unplanned pregnancy. When you are taking valproate it is extremely important to plan a pregnancy. You need to see your doctor 6 to 12 months before you would like to become pregnant so that you can reduce any risks to your baby.

All antiepileptic medicines in pregnancy have the potential to harm an unborn child but the risks are higher with some medicines, including sodium valproate, especially early in your pregnancy and at higher doses. If you have epilepsy, having seizures while you are pregnant can also harm your unborn child so it is important to keep taking an anti-epileptic medication.
You and your doctor will agree on a plan about how to manage your medicines and your dose.
If you are pregnant or think you might be pregnant, keep taking your medicine at the right dose, and contact your doctor, tell them you think you are pregnant and get an urgent appointment to see them.

Possible side effects

Like all medicines, valproate can cause side effects; often side effects improve with time as your body gets used to the new medicine.

Side effects	What should I do?
Feeling sleepy, drowsy or tired Feeling dizzy, or faint	This is common when starting sodium valproate. Be careful when driving or using tools until you know how this medicine affects you. Limit or avoid alcohol. Tell your doctor if troublesome.
Weight gain Hair loss Changes in menstruation (periods)	Tell your doctor if troublesome.
Changes in mood, personality or behaviour	Tell your doctor.
Shaky hands or unsteady on your feet	Tell your doctor as your dose may need to be adjusted.
Feeling sick (nausea) Stomach upset	Try taking sodium valproate with food Tell your doctor if troublesome - you may need to change to the EC tablet.
Easy bruising, feeling tired, looking pale, getting sick often	Tell to your doctor as you may need a blood test.
Signs of an allergic reactions such as skin rash, itches, hives, swelling of the face, lips and mouth, problems breathing	Tell your doctor immediately or ring HealthLine 0800 611 116
Signs of problems with your liver such as severe tummy pain, yellowing of the eyes and skin, dark urine.	Tell your doctor immediately or ring HealthLine 0800 611 116

Interactions

Valproate interacts with some other medications and herbal supplements, so check with your doctor or pharmacist before starting sodium valproate or before starting any new medicines. Do not take indigestion medication (antacids) within 2 hours of taking sodium valproate.

Learn more

Epilim Medsafe Consumer Information Sheet
For adults: sodium valproate New Zealand Formulary Patient Information
For children: sodium valproate New Zealand Formulary for Children
For women: Are you taking medicines for epilepsy, mood or pain? ACC, New Zealand

References

sodium valproate New Zealand Formulary Patient Information
sodium valproate New Zealand Formulary for Children
Prescribing issues associated with anticonvulsant medications for epilepsy BPAC, 2009

Credits: Sandra Ponen, Pharmacist, NZ. Reviewed By: Angela Lambie, Pharmacist, Auckland Last reviewed: 14 Dec 2017 Page last updated: 17 Dec 2018

Information for clinicians

Antiepileptic medicines for females

Benefits and risks of taking antiepileptic medicines for females
Key messages All antiepileptic medicines taken in pregnancy have the potential to harm an unborn child. Advise female patients on the importance of two effective forms of contraception, if they are of childbearing age and are potentially sexually active. Identify and annually review your female patients taking antiepileptic medicines. Check the appropriateness of antiepileptic medicines, and reinforce relevant messaging. Clearly document your review and discussion. Advise female patients of the importance of planning a pregnancy in consultation with a doctor or specialist. It is the prescriber's responsibility to ensure that all their female patients are aware of the risks associated with taking antiepileptic medicines while pregnant. Do not prescribe sodium valproate to sexually active females of child bearing age unless there is no reasonable alternative as sodium valproate has the highest risk of harm. In the event of an unplanned pregnancy while taking antiepileptic medicines, advise your patient to continue their medicines, and that you will seek urgent specialist advice. Read more: Benefits and risks of taking antiepileptic medicine for females, ACC, New Zealand, 2017

Benefits and risks of taking antiepileptic medicines for females

Key messages

All antiepileptic medicines taken in pregnancy have the potential to harm an unborn child.
Advise female patients on the importance of two effective forms of contraception, if they are of childbearing age and are potentially sexually active.
Identify and annually review your female patients taking antiepileptic medicines. Check the appropriateness of antiepileptic medicines, and reinforce relevant messaging. Clearly document your review and discussion.
Advise female patients of the importance of planning a pregnancy in consultation with a doctor or specialist.
It is the prescriber's responsibility to ensure that all their female patients are aware of the risks associated with taking antiepileptic medicines while pregnant.
Do not prescribe sodium valproate to sexually active females of child bearing age unless there is no reasonable alternative as sodium valproate has the highest risk of harm.
In the event of an unplanned pregnancy while taking antiepileptic medicines, advise your patient to continue their medicines, and that you will seek urgent specialist advice.

Read more: Benefits and risks of taking antiepileptic medicine for females, ACC, New Zealand, 2017

Improving adherence

Helping patients with epilepsy adhere to their medicines
Key messages Good adherence to anti-epileptic medicines is necessary to maximise a patient’s chance of being seizure free. However, poor adherence is reported in up to half of patients with epilepsy. Forgetfulness is a major contributor to patients, or their caregivers, missing doses Encourage patients and caregivers to set a routine for taking medicines and to use reminder techniques such as alarms, smart phone apps, medicine blister packs, pill boxes or a diary so that doses are not forgotten Education is a key part of helping patients and caregivers understand the need for regular dosing of anti-epileptic medicines Simple medicine regimens and 90-day dispensings of medicines can help improve adherence; review a patient’s prescriptions and how often they need to visit a pharmacy to see if changes can be made. Read more: Helping patients with epilepsy adhere to their medicines BPAC, Sep 2017

Helping patients with epilepsy adhere to their medicines

Key messages

Good adherence to anti-epileptic medicines is necessary to maximise a patient’s chance of being seizure free. However, poor adherence is reported in up to half of patients with epilepsy.
Forgetfulness is a major contributor to patients, or their caregivers, missing doses
Encourage patients and caregivers to set a routine for taking medicines and to use reminder techniques such as alarms, smart phone apps, medicine blister packs, pill boxes or a diary so that doses are not forgotten
Education is a key part of helping patients and caregivers understand the need for regular dosing of anti-epileptic medicines
Simple medicine regimens and 90-day dispensings of medicines can help improve adherence; review a patient’s prescriptions and how often they need to visit a pharmacy to see if changes can be made.

Read more: Helping patients with epilepsy adhere to their medicines BPAC, Sep 2017

Monitoring

Monitoring
Baseline investigation Identify any history of haematological or hepatic disease. Measure FBC, LFT, electrolytes and creatinine. Advise the patient to stop treatment and seek medical attention if dermatological, liver or haematological-related adverse effects develop. (see below). Ongoing monitoring Measure weight, FBC, LFTs every 3 months for one year and then annually. Patients should seek medical advice if they develop fever, infection, rash, abdominal pain, vomiting, yellowing of the skin, bruising or bleeding. Reproductive endocrine disorders, e.g. menstrual disorders, polycystic ovary syndrome and hyperandrogenism are more common in females taking valproate. Valproate can reduce bone mineral density and the patient’s diet should contain adequate calcium. Weight-bearing exercise can improve balance and bone strength. Read more: Bipolar disorder: Identifying and supporting patients in primary care July 2014

Baseline investigation

Identify any history of haematological or hepatic disease.
Measure FBC, LFT, electrolytes and creatinine.
Advise the patient to stop treatment and seek medical attention if dermatological, liver or haematological-related adverse effects develop. (see below).

Ongoing monitoring

Measure weight, FBC, LFTs every 3 months for one year and then annually.
Patients should seek medical advice if they develop fever, infection, rash, abdominal pain, vomiting, yellowing of the skin, bruising or bleeding.
Reproductive endocrine disorders, e.g. menstrual disorders, polycystic ovary syndrome and hyperandrogenism are more common in females taking valproate.
Valproate can reduce bone mineral density and the patient’s diet should contain adequate calcium. Weight-bearing exercise can improve balance and bone strength.

New Zealand Formulary

sodium valproate

Control of the epilepsies

Medsafe NZ Data Sheet

Epilim