Mood Stabilisers: Sodium Valproate

Question 1

What are the indications of sodium valproate?

Answer 1

Comparable efficacy to lithium as a mood stabilizer. If lithium (and an atypical antipsychotic) is ineffective or unsuitable in acute mania. Used in combination with lithium for rapid cycling bipolar affective disorder.

Question 2

What is the mechanism of action of sodium valproate?

Answer 2

Valproate is a simple branched-chain fatty acid. It is thought to inhibit the catabolism of GABA, ↓ turnover of arachidonic acid and activate extracellular signal-regulated kinase. This alters synaptic plasticity, interferes with intracellular signalling, promotes brain-derived neurotrophic factor (BDNF) expression and ↓ levels of protein kinase C.

Question 3

What are the side effects of sodium valproate?

Note: GI and VALPROATE

Answer 3

• GI disturbances
• Very fat (↑ weight )
• Aggression
• LFTs ↑
• Platelets low (thrombocytopenia)
• Reversible hair loss (in 10%)
• Oedema (peripheral)
• Ataxia
• Tremor/ tiredness/ teratogenic
• Emesis

Question 4

Whar are the contraindications of sodium valproate?

Answer 4

Avoid in pregnancy (can cause neural tube defects in the fetus and result in spina bifida), hepatic dysfunction and porphyria.

Question 5

Briefly describe the monitoring of sodium valproate therapy

Answer 5

FBC (to check platelets) before therapy and before any surgery.

Monitor LFTs and prothrombin time (PT) before therapy and during first 6 months.

Pregnancy test and weight/BMI before commencing.

Check LFTs, FBC and weight again after 6 months then annually.

Question 6

What is the dose of sodim valproate?

Answer 6

Dose started at 250-500mg daily, and subsequently titrated upwards.

Question 7

What is the route of administration of sodium valproate?

Answer 7

Oral.

IV only used for epilepsy.