Fatty acid derivative·Neurology - Anticonvulsants

Sodium valproate (oral/IV)

Bipolar disorder (mania), all forms of epilepsy (generalised and focal)

Authority requiredPBSMOOD STABEpilim, Epilim CR, Valpro500 mg EC tablet+2

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At a glance

Target Range

350–700 umol/L

Half-life

14 h

High risk: Teratogenic

CRITICAL

Caution: Hepatic

MONITOR

Cautions

Avoid / Cautions

Active liver disease, mitochondrial disorders (POLG mutations), urea cycle disorders. Pregnancy Category D (Functionally Category X). Causes neural tube defects (spina bifida) in 10% of cases, and drops the child's IQ by 10 points. MUST NOT be used in women of childbearing age unless all other options have failed and strict dual-contraception is enforced.

Where it stands

Rapid Summary

Overview

Broad-spectrum anticonvulsant and highly effective mood stabiliser for Bipolar Mania. Extremely dangerous in women of childbearing age.

Clinical Focus

The most teratogenic drug in neurology/psychiatry. Causes horrific birth defects and neurodevelopmental destruction.

Bottom Line

Sodium valproate (oral/IV) is a broad-spectrum anticonvulsant and mood stabiliser, but is absolutely contraindicated in women of childbearing potential due to teratogenicity and requires hepatic and haematological monitoring.

Formulation & Access

Brand Names

Epilim, Epilim CR, Valpro

Oral Routes

Enteric-coated tablets (100, 200, 500 mg). Crushable tablets (100 mg). CR Tablets (200, 500 mg). Oral liquid.

Parenteral

Ampoules (400 mg powder) for IV use.

Prescribing & PBS

Authority Required (PBS). Special consent forms often mandated for females < 50 yrs.

Indications & Use

Primary

PBSTGA

Bipolar disorder (mania), all forms of epilepsy (generalised and focal).

Off-Label

OFF

Migraine prophylaxis.

Clinical Place

First-line for generalized epilepsy in males. First-line for acute bipolar mania.

Quick reference

Class & Role

Fatty acid derivative — Broad-spectrum anticonvulsant and highly effective mood stabiliser for Bipolar Mania.

Route / Formulation

Enteric-coated tablets (100, 200, 500 mg). Crushable tablets (100 mg). CR Tablets (200, 500 mg). Oral liquid. (Epilim, Epilim CR, Valpro)

Usual Dose & Max

Start PO 500 mg BD (enteric-coated or CR). Titrate rapidly to target range. Maintenance 1000-2000 mg/day. Max 2500 mg/day (Titrated to response and blood levels).

Key Indication Doses

Bipolar Mania: Start PO 500 mg BD (enteric-coated or CR). Titrate rapidly to target range. Maintenance 1000-2000 mg/day. Epilepsy: PO Start 400-600 mg/day. Increase until seizures are controlled. Max 2500 mg/day. Status Epilepticus: IV 20-30 mg/kg bolus, then continuous infusion.

Best Uses

Key Risks

Hepatic: Fatal hepatotoxicity (highest risk in children < 2 years on polytherapy). Hyperammonemic encephalopathy (confusion/coma without elevated LFTs). Haematological: Thrombocytopenia (low platelets), impaired coagulation. Metabolic/GI: Significant weight gain, severe nausea (reduced with CR forms), PCOS-like syndrome, hair loss, pancreatitis.

Key Interactions

Lamotrigine. Valproate completely blocks the clearance of Lamotrigine, doubling its levels and causing fatal SJS/TEN. If combining, Lamotrigine dose must be halved and titrated glacially. Meropenem/Carbapenems. Within 24 hours of starting Meropenem, Valproate levels drop to ZERO. The patient will seize. Avoid combination.

Monitoring

Baseline and routine LFTs, FBC (platelets). Measure TDM (Valproate levels, target 350-700 umol/L). Check Ammonia levels if the patient becomes acutely confused or lethargic (Hyperammonemic encephalopathy).

Clinical Pearl

Doses > 1500mg/day often cause thrombocytopenia. Always check a recent FBC before taking a Valproate patient to surgery, or they will bleed out.

Access

Authority requiredEpilim, Epilim CR, Valpro500 mg EC tablet

Brand: Epilim, Epilim CR, Valpro
PBS status: Authority required
Formulation: Enteric-coated tablets (100, 200, 500 mg). Crushable tablets (100 mg). CR Tablets (200, 500 mg). Oral liquid.

From this page

No calculator, monitoring schedule or factsheet is linked to this medicine page yet.

Cautions

Avoid / Cautions