Sodium Valproate

Key points

• Sodium valproate is used in epilepsy and works by increasing GABA activity. It is NO LONGER simply 'first-line for generalised seizures': NICE NG217 offers a CHOICE of lamotrigine, levetiracetam or sodium valproate for generalised tonic-clonic seizures, and valproate must not be used in women or girls able to have children.
• MHRA (in force 31 January 2024): valproate must NOT be started in any new patient, male or female, under 55 years unless two specialists independently document that there is no other effective or tolerated treatment · in women and girls of childbearing potential it may only be used under a Pregnancy Prevention Programme.
• TERATOGENICITY is the headline adverse effect — neural tube defects and neurodevelopmental disorder. Other important effects: hepatotoxicity, pancreatitis, hyponatraemia/SIADH, thrombocytopenia, tremor and encephalopathy from hyperammonaemia. Adverse effects
• P450 inhibitor
• gastrointestinal: nausea
• increased appetite and weight gain
• alopecia: regrowth may be curly