The risks with using sodium valproate

I was impressed with the thought-provoking piece concerning the use of sodium valproate to treat epilepsy in pregnant women and the associated risks (PJ 2014;292:482).

Obviously there are far wider issues than just use of sodium valproate in pregnant women. Sodium valproate is used for many other conditions, both licensed and unlicensed. I am aware some of my patients, under hospital support, use it to treat anorexia nervosa, panic attacks, anxiety disorder, post-traumatic stress disorder, migraine and bipolar disorder. My sister, a psychiatric team leader, tells me it is also used to control acute episodes of mania and acute stress reaction. Therefore it would be safe to presume the same risks exist outside the use of sodium valproate in epilepsy.

It makes me wonder: are the risks the same with other valproic acid derivatives such as Depakote and other brands and generics; how much of these teratogenic risks are also related to other factors such as environmental factors, lifestyle, poor public health and genetics; how much risk, if any, is there to women of childbearing age (as opposed to pregnant) using sodium valproate; are there any long-term effects in children who have avoided any teratogenic defects; how much added risk is there with lactation; and is the risk of valproate use greater than the risk of epilepsy in pregnant women?

This article affects us all because, if further research reinforces what has been said in the article, there will be significant interest and concern from patient groups, as well as parliamentary and media interest. The use of “yellow cards”, working with prescribers, professional support and warnings on patient medication records would be a start but the Royal Pharmaceutical Society and our profession need to be ready and prepared. We will need to address how best to restrict use in high-risk groups, how best our messages are communicated to patients without causing fear and what alternatives are available.

Also we need have more evidence before we avoid a loss in confidence in what is a highly efficacious medicine for those where conditions are well controlled and to think of suitable alternatives for those potentially at higher risk.

The views expressed here are Mr Dajani’s own and do not necessarily reflect those of the board or Society. — EDITOR.