Extreme care needed with sodium valproate and pregnancy and women of childbearing potential

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Extreme care needed with sodium valproate and pregnancy and women of childbearing potential

Sodium valproate should not be used:

  • In girls or women of childbearing potential unless other treatments are ineffective or not tolerated.1
  • During pregnancy for the treatment of epilepsy unless there is no suitable alternative treatment.1
  • During pregnancy for the treatment of bipolar disorder.1

As comparison, the risk of congenital malformations was highest with sodium valproate, with approximately 10–11% of pregnancies affected, followed by phenobarbital, phenytoin and carbamazepine.2 There are no antiepileptic medicines risk-free when used during pregnancy.2

If pregnancy occurs, input from O&G, neurology and psychiatry is advised. A useful handout for clinicians is available.3

To prevent pregnancy two forms of effective contraception should be used by women who are taking an antiepileptic medicine; N.B. some hormonal contraceptives interact with enzyme-inducing antiepileptic medicines.2

References:

  1. Use of sodium valproate (Epilim) in girls and women – Change to indications and contraindications. Medsafe (2019)
  2. Balancing the benefits and risks of prescribing antiepileptic medicines in women. bpacnz (2018)
  3. Benefits and risks of taking antiepileptic medicine for females. ACC (reviewed 2019)

    Gems are chosen by the Goodfellow director Dr. Bruce Arroll to be either practice changing or practice maintaining. The information is educational and not clinical advice.

     
    This Gem is supported by:
    As published in NZ Doctor 20/11/2019