Sodium valproate | Epilepsy clinician handbook
- A good ‘all rounder’. Used first line in genetic generalised epilepsies (e.g. CAE, JAE, JME) and in refractory epilepsies such as Dravet Syndrome.
- Avoid use in suspected mitochondrial disorders.
- In the very young (<2 years old), consider the risk of hepatotoxicity. The aetiology of the neurological problem is helpful in deciding whether to use or not.
There are significant concerns regarding teratogenicity and all women of child bearing age must be alerted to this.
Possible side effects
- Appetite and weight gain (very common and can be intolerable).
Other notable side effects:
- Thrombocytopenia (usually dose-related)
- Sedation
- Rash
- Dystonia/tremor (at higher doses)
- Pancreatitis
- Hepatotoxicity is idiosyncratic and those at most risk are children under the age of 2, metabolic aetiology, and/or multiple drugs, avoid in mitochondrial disorders
- There is some association with ovarian cysts.
- Rarely a picture of pseudodementia is described.
- For a complete list of adverse effects, appropriate formularies should be consulted.
Interactions and precautions
Valproate in pregnancy
- Sodium valproate has been associated with significant concerns of teratogenicity (i.e. malformations, cognitive impairment, and Autistic Spectrum Disorder).
- This is particularly true at higher dosages.
- The risk of teratogenicity increases with increasing dosage.
- It is important clinicians and women of child bearing age are aware of this risk.
- Ideally, pregnancies in women with epilepsy should be planned and managed by a neurologist.
- Medication choices should be selected and discussed keeping in mind the safety of mother and foetus.
- The Epilepsy Society Australia (ESA) has developed guidelines and position statements on certain clinical issues.
- The NICE Guideline on Epilepsies in children, young people and adults, was updated in April 2022 with advice regarding valproate use in women of childbearing age.