The first stop for professional medicines advice
Medicines Monitoring

Valproic acid and Sodium valproate monitoring

Published
Topics: MonitoringSodium valproateValproic acid
Using this page · Individualise medicines monitoring

This medicines monitoring page has been written using publications and expert opinion. It is designed to save clinician time, but not replace professional responsibility. When using this page you should: ensure an individualised monitoring plan is developed in partnership with the patient and take account of any locally agreed advice and guidance.

Contents
  1. Before starting
    1. Required
  2. Continued until stable
    1. Required
  3. Ongoing once stable
    1. Required
    2. Before surgery or following spontaneous bleeding or bruising
  4. Abnormal results
    1. Hepatic effects
    2. Haematological effects
    3. Pancreatitis
  5. Notes
    1. Advice to patients
    2. Brand prescribing
    3. Conception
  6. Bibliography

Before starting

Required

  • Baseline
    • Body mass index
    • Clotting screeningincluding bleeding time and coagulation tests
    • Full blood count
    • Liver function tests
    • Platelet count
    • Pregnancy testsee advice on valproate use by women and girls

Specialist initiation only

Only specialists can initiate or recommend initiation in adults and children.

Continued until stable

Required

  • Liver function tests

Ongoing once stable

Required

  • At 6 months, then annually
    • Body mass index
    • Full blood count
    • Liver function tests

Before surgery or following spontaneous bleeding or bruising

  • Once
    • Clotting screeningincluding bleeding time and coagulation tests
    • Full blood count

Abnormal results

Hepatic effects

Raised liver enzymes are usually transient but patients should be assessed clinically and FBC (including platelets) and liver function (including prothrombin time and coagulation tests) monitored until return to normal. Discontinue if abnormal liver function.

Haematological effects

Discontinue if abnormally prolonged prothrombin time or blood dyscrasias.

Pancreatitis

In case of pancreatitis, valproate should be discontinued.

Notes

Advice to patients

Advise patients and carers to be aware of the signs of:

  • Blood or liver disorders; advise them to seek immediate medical attention if symptoms develop
  • Pancreatitis; advise them to seek immediate medical attention if symptoms such as abdominal pain, nausea and vomiting develop

Brand prescribing

Valproate is classified as a category 2 drug. Hence, for epilepsy only, clinical judgement is required when switching between branded original and generic products.

Conception

There is a significant risk of birth defects and developmental disorders in children born to women who take valproate during pregnancy.

The MHRA advice provides full information on the risks and issues.

Healthcare professionals can also refer to:

Bibliography