EPILEPSY: SODIUM VALPROATE Flashcards
Category
Category 2
Maintained on a specific brand based on clinical judgement (seizure frequency, treatment history etc.)
Indication
- all forms of epilepsy
- migraine prophylaxis
- mania
MoA
Weak inhibitor of neuronal sodium channels.
Stabilises resting membrane potential.
Reduces neuronal excitability.
Patients under 55
male or female
- SV should not be initated where alternative is available
- If no alt = 2 specialists must independently document this
Contraindications
- Acute porphyrias
- Personal/ family history of severe hepatic dysfunction
Main risk
Highly teratogenic
1g = max in pregnancy
> = increased teratogenicity
What type of seizures is valproate used for?
1st line in all types of generalised seizures.
Sodium valproate + pregnancy
HIGHLY TERATOGENIC
- can lead to congenital malformations and neurodevelopmental disorders
- prescribers should NOT prescribe SV to females of childbearing potential
Contraindicated in pregnant women for BPD and only considered in epilepsy if no alternative.
When would SV be offered to women with childbearing potential
- No other suitable treatment
- Likelihood of pregnancy considered
- PPP in place
- Risks + benefits
Pregnancy Prevention Programme (PPP)
- ONE highly effective method of contraception (e.g. IUD or implant) or TWO complementary forms of contraception
including a barrier method. - Fully informed of the risks of use in pregnancy, and a signed risk acknowledgement form.
- Seen annually by specialist for review.
PPP - Pharmacists role
Provide valproate patient card.
Remind pt. of risks in pregnancy/need for highly effective contraception.
Remind of need for annual specialist review
Dispense as whole pack - always give PIL
Refer/contact GP if pt.not taking highly effective contraception.
Major side effects to look out for
2
- Hepatic dysfunction
- Pancreatitis
report signs + withdraw treatment
Side effects
Hepatotoxicity
Blood disorders
Pancreatitis
Hyponatraemia
GI: D+N
Transient hair loss
Weight gain
Hepatotoxicity
Discontinue if abnormally prolonged prothrombin time
Monitor LFTs
* Persistent vomiting
* Abdominal pain
* Jaundice
* Malaise
* Drowsiness
Who is at increased risk of liver toxicity from SV?
- Children < 3
- Metabolic disorder
- Organic brain disease
- Severe seizures + mental retard
- Multiple AEDs