Prescribing GP

Question 1

Valproate in female patients -

what does the MHRA advise?

Answer 1

• do not prescribe valproate medicines for epilepsy or bipolar disorder in women and girls unless other treatments are ineffective or not tolerated; migraine is not a licensed indication
• ensure women and girls taking valproate medicines understand the 30–40% risk of neurodevelopmental disorders and 10% risk of birth defects and are using effective contraception
• valproate use in women and girls of childbearing potential must be initiated and supervised by specialists in the treatment of epilepsy or bipolar disorder

Leaflets are here: https://www.gov.uk/government/publications/toolkit-on-the-risks-of-valproate-medicines-in-female-patients

Question 2

Adrenalin autoinjectors -

MHRA guidance?

Answer 2

• prescribe 2 adrenaline auto-injectors, which patients should carry at all times
• particularly important for people who also have allergic asthma because they are at increased risk of a severe anaphylactic reaction
• people with allergies and their carers have been trained to use their injector, as technique varies between injectors
• that people with allergies and their carers obtain and practise using a trainer device (available for free from the manufacturers’ websites)
• use adrenaline auto-injector at first signs of a severe allergic reaction:
  • swelling in the throat (altered voice, difficulty swallowing or breathing)
  • wheezing
  • dizziness, feeling faint, tiredness (symptoms of low blood pressure)
• If in doubt about severity, or if previous reactions have been severe, use an adrenaline auto-injector.
• If not feeling better after the first injection, the second auto-injector should be used 5–15 minutes after the first.
• Always call 999 after using the auto-injector.

Links to leaflets and training videos are here:

https://www.gov.uk/drug-safety-update/adrenaline-auto-injectors-updated-advice-after-european-review