Sodium valproate
Mood stabiliser
Indications
Bipolar — acute mania (where lithium contraindicated/ineffective)Maintenance
Adult dose
Start 500–750 mg/day in 2 divided doses; titrate to clinical effect, usual 1000–2000 mg/day.
Common side effects
TremorWeight gainHair loss/thinningSedationGI upset
Serious side effects
HepatotoxicityPancreatitisThrombocytopeniaHyperammonaemic encephalopathyTeratogenicity (neural tube defects, neurodevelopmental disorder)
Contraindications
Pregnancy (absolute, unless Pregnancy Prevention Programme)Women of childbearing potential without PPPHepatic impairmentPorphyriaMitochondrial disorders (POLG)
Monitoring
- LFTs and FBC at baseline, after 6 months, then annually
- Weight
- Annual PPP review in women of childbearing potential
Notable interactions
- Lamotrigine — raises levels (halve lamotrigine dose)
- Carbamazepine — bidirectional
- Aspirin raises free fraction
- Warfarin — increased bleeding
Notes
MHRA: must not be used in any patient <55 yrs unless 2 specialists document no alternative.
Curated reference based on BNF, Maudsley Prescribing Guidelines and NICE. Verify against current BNF and local guidelines before prescribing.