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Ask the Educator - Sodium Valproate

Q: I have heard people in my support group talk about Sodium Valproate (Epilim) used in the treatment of epilepsy and there was a query for women and girls. Can you provide some information?
A: What is it?
 
Sodium Valproate is a medicine used for the treatment of epilepsy in adults and children. It belongs to a group of medicines called anticonvulsants. It is sold under several brand names including: Epilim, Sandoz, Sodium Valproate and Valpro. It was released onto the market almost 50 years ago.
 
Why is it used?
These medicines are thought to work by controlling chemicals in the brain which send signals to nerves so seizures do not happen. The medication aims to decrease or stop seizures in people living with epilepsy. It may be used by itself or combined with other medications.
 
It may also be prescribed to treat migraines and bipolar disorder.
 
Some background
There have been warnings about the use of Sodium Valproate for some years for specific groups including female children, female adolescents and women of childbearing age (or childbearing potential).
 
Teratogenic risks (drugs, chemicals or infections which can cause abnormal foetal development) have been associated with Sodium Valproate and other medicines of that kind, if taken in the first trimester of pregnancy.
 
In 2015 a joint taskforce of the International League Against Epilepsy (ILEA) on Valproate in the treatment of epilepsy in women and girls made a number of recommendations including consideration in each individual circumstance of the likely effectiveness of Sodium Valproate compared to alternatives for the seizure type being experienced. There should also be discussion on risk to the foetus of uncontrolled seizures as a result of medication changes and diminished or delayed seizure control.
 
The Epilepsy Society of Australia (ESA) recognises the Sodium Valproate is associated with a greater risk to an unborn child when taken by pregnant women then other anti-epileptic drugs, however according to the ESA the risk is highly dependent on the dose.
 
Data from the Australian Pregnancy Register shows a decline in the last decade in the dose and number of prescriptions to women enrolled on the Australian Pregnancy Register. There has been a fall in the mean Sodium Valproate dose of 1061 mg per day (1999- 2005) to a dose of 748 mg per day (2006-2012).
 
According to the 2018 Position Statement issued by the ESA Sodium Valproate remains a valuable treatment option in many patients with epilepsy, including a carefully selected group of women.
 
Things to consider
As with all medical treatments, the benefits of a treatment need to be balanced against the potential risks.
 
Treatment choices should consider the types of seizures being experienced, whether the woman is considering/planning a pregnancy and the medication dosage.
 
The choice of treatment for women of childbearing age should be based on a shared decision between clinician and patient.
 
Position statement: The use of Sodium Valproate in women of childbearing age 2018: Professor Frank Vajda (Australian Pregnancy Register); Dr Michelle Kiley (President, ESA)