Sodium Valproate

Brands - Epilim, Depakote, Convulex, Episenta, Epival, Syonell, Belvo & Dyzantil

It works by increasing GABA activity.

• associated with weight gain, tremor, hair loss, teratogenicity and polycystic ovary disease

Na Valproate → low sodium

Valproate SE -very common -> nausea, to take with food

A - appetite increase, weight gain

L - liver failure

P - pancreatitis, P450 inhibitor

R - reversible Hair loss, alopecia (regrowth may be curly)

O - oedema

A - ataxia,

T - teratogenicity, tremor, thrombocytopenia

E - hyperammonemic encephalopathy: L-carnitine may be used as treatment if this develops

!! May impair fertility in men.

Fertility dysfunctions are in some cases reversible, at least 3 months after treatment discontinuation. Limited numbers of case reports suggest a dose reduction may improve fertility function. However, in some cases, the reversibility of male infertility was unknown.

Teratogenicity:

• neural tube defects
• maternal use of sodium valproate is associated with a significant risk of neurodevelopmental delay in children
• The MHRA and NICE have strengthed their advice against sodium valproate use recently: Valproate must not be started for the first time in people (male or female) younger than 55 years, unless 2 specialists independently consider and document that there is no other effective or tolerated treatment, or there are compelling reasons that the reproductive risks do not apply.

Hepatotoxicity:

Mitochondrial dysfunction is thought to be a key factor in hepatotoxicity associated with sodium valproate. Valproate is recognised to lower carnitine levels. This may in turn affect mitochondrial function, leading to increased levels of ammonia and microvascular steatosis.