Sodium Valproate

Question 1

Sodium Valproate - Indications (3)

Answer 1

1) Prophylaxis of general seizures.
2) Second-line in the acute treatment of status epilepticus if benzodiazepines are non-effective.
3) Acute treatment (manic episodes) + prophylaxis of Bipolar disorder

Question 2

Sodium Valproate - Side effects (most common)

Answer 2

GI :

• Nausea
• Diarrhoea
• Gastric Irritation

Neuro:

• Tremor
• Ataxia
• Behavioural Disturbance

Other:

• Thrombocytopenia
• Increased liver enzymes
• Hypersensitivity reactions

Question 3

Sodium Valproate - Contraindications

Answer 3

1. Women of childbearing age
2. Around the time of conception.
3. First trimester of pregnancy
   Sodium Valproate is known to cause birth defects.
4. Hepatic Impairment

Question 4

Sodium Valproate - Use with caution in

Answer 4

Renal Impairment (dose reduction)

Question 5

Sodium Valproate - Interactions

Answer 5

1) Lamotrigine

2) CYP inducers : decreases blood concentration of SV reducing its efficacy (carbamazepine, phenytoin)
- this is because SV is metabolised by CYP enzyme.

3) Drugs that are metabolised by CYP. Their concentration will increase (warfarin)
- this is because SV inhibits hepatic enzymes.

4) Drugs that lower seizure threshold (antipsychotics, phenytoin)
5) ▴CYP inhibitors (e.g. macrolides, protease inhibitors)

Question 6

Sodium Valproate - patient advice

Answer 6

• Advise it be taken with food (reduce GI symptoms)
• Explain it will reduce frequency of seizures
• For women discuss pregnancy + contraception