Sodium Valproate

What is sodium valproate?

Sodium valproate is a prescription medicine used to treat certain neurological and psychiatric conditions. It belongs to a group of medicines called antiepileptic drugs (AEDs) and is available under brand names such as Epilim, Episenta, Epival, and Dyzantil. 

What is sodium valproate used for?

Sodium valproate is primarily used to[1]: 

• Treat epilepsy – to control various types of seizures 

• Manage bipolar disorder – to stabilise mood and prevent manic episodes, though only certain brands are licensed for this indication 

• Prevent migraines – though this use is less common 

How does sodium valproate work?

Sodium valproate increases the levels of a calming chemical in the brain called gamma-aminobutyric acid (GABA). This helps to reduce the likelihood of seizures, stabilise mood swings in bipolar disorder and possibly prevent migraine attacks[1]. 

Who can take sodium valproate?

Sodium valproate can be taken by adults and children, but it is not suitable for everyone. All men and women of child-bearing age should not be started on sodium valproate unless two specialists independently agree there is no other effective or tolerated treatment, or there are compelling reasons the reproductive risks do not apply due to the risk to unborn babies.  

Patients who are taking sodium valproate should be informed of the risk and meet the conditions of the pregnancy prevention programme, including using one highly effective contraception (such as IUD or implant) or two complementary forms including a barrier method (such as a contraception pill and condoms). Men should use effective contraception i.e. condoms plus contraception used by their partner. It may not be suitable for people with liver problems, urea cycle disorders, mitochondrial disorders, or porphyrias[1]. 

For women and girls of childbearing age, if you do need to take sodium valproate then your doctor will enrol you on the valproate pregnancy prevention programme, called Prevent to ensure the risks of treatment are understood[1]. 

For men taking sodium valproate, your fertility could be affected (may be reversible on stopping treatment of dose reduction). It may also cause learning or behavioural problems in your child if your partner becomes pregnant while you're taking sodium valproate[1]. 

Please tell your doctor or pharmacist about any conditions you may have or medication you take before you start treatment, and always follow the instructions in the Patient Information Leaflet[2].

What is the Pregnancy Prevention Programme?

It aims to stop you from accidentally getting pregnant while taking sodium valproate due to the risk of harm to the unborn child. It includes[1]: 

• An annual review by a clinician who will assess your treatment, provide a Patient Guide, and check they have been reviewed by a specialist (have an in-date risk acknowledgement form). Men starting sodium valproate should also complete a Risk Acknowledgement Form.  

• Contraception advice to make sure you’re using reliable forms of contraception even if you’re not currently sexually active e.g. one highly effective contraception (such as IUD or implant) or two complementary forms including a barrier method (such as a contraception pill and condoms) 

You should let a doctor know if you become pregnant or are planning a pregnancy. This is not just for women, men who could possibly have or are planning to have children within the next year, should discuss sodium valproate with a doctor[1]. 

For more information, read the NHS valproate guide for men and for women. 

What is the typical dosage of sodium valproate?

Dosage varies depending on age, condition, and response to treatment. Treatment typically starts at a low dose and is increased gradually[1].  

The usual dose of sodium valproate for treating epilepsy in adults and children aged 12 years and over is 600mg to 2,000mg a day, as 1 dose or split into 2 doses. Some people may take the maximum dose of 2,500mg a day in 1-2 divided doses. For younger children aged 1 month to 11 years, the doctor will use your child's weight to work out the right dose for them[1]. 

The usual dose for treating bipolar disorder in adults is 750mg to 2,000mg a day, as 1 dose or split into 2 doses. The usual dose for preventing migraine in adults is 400mg to 1,500mg, split into 2 doses[1]. 

How do you take sodium valproate?

It’s available as tablets, capsules, a liquid that you swallow, and as granules that you can mix with food or drink. You should take with or just after food to reduce stomach upset. Swallow tablets whole – do not crush or chew unless advised[1]. 

Can you stop taking sodium valproate?

Do not stop suddenly, especially if you have epilepsy, as this can trigger or worsen seizures. Stopping treatment of valproate should be done gradually under the care and supervision of a medical professional. Always speak to your pharmacist or GP first[1]. 

What do you do if you take too much sodium valproate?

Taking too much sodium valproate can be dangerous. Symptoms may include[1]: 

• Nausea or vomiting 

• Dizziness or drowsiness 

• Breathing problems 

• Loss of consciousness 

• Confusion or memory loss 

• Smaller pupils of eyes 

Call 999 or go to A&E immediately if an overdose is suspected. 

What do you do if you forget to take sodium valproate?

If you forget a dose, take it as soon as you remember. If it’s nearly time for your next dose, skip the missed one. Do not take two doses at once[1]. 

What medicines can’t you take with sodium valproate?

Sodium valproate can interact with several medications, including[1]: 

• Other epilepsy drugs (e.g. carbamazepine, phenytoin) 

• Antidepressants and antipsychotics (e.g. venlafaxine, quetiapine, diazepam, olanzapine) 

• Cannabidiol 

• Methylphenidate 

• Antibiotics (e.g. erythromycin) 

• Blood thinners (e.g. warfarin) 

• Cholesterol medication like cholestyramine 

• Malaria prevention medicine 

• Aspirin 

• Cimetidine HIV and AIDS medication like ritonavir 

Please note this is not a complete list, always inform your doctor or pharmacist about all medications and supplements you take before you start a new medicine, and follow the instructions in the Patient Information Leaflet[2].

What are the side effects of sodium valproate?

The most common side effects may include[1]: 

• Nausea or vomiting 

• Stomach pain 

• Diarrhoea 

• Dry or sore mouth, and swollen gums 

• Headaches 

• Weight gain 

• Hair thinning or falling out 

• Tiredness 

• Irregular periods 

• Liver problems (especially in children) 

Rarer, but more serious side effects may include[1]: 

• Signs of liver damage (yellowing of skin or eyes) 

• Unusual bruising or bleeding 

• Severe abdominal pain – could be a sign of acute pancreatitis 

• Shakes or unusual eye movements 

You should contact your GP if you experience any of these symptoms. In rare cases, the medicine may cause a serious allergic reaction (anaphylaxis). You should call 999 or visit A&E immediately if you believe this is happening[1]. 

Symptoms of anaphylaxis include[1]:  

• Difficulty breathing  

• Tightness in throat and chest  

• Swelling of the tongue or throat  

• Feeling faint or dizzy  

• Blue/grey skin or lips  

• Loss of consciousness 

If you experience any side effects, including those not listed, you are encouraged to report them via the Yellow Card Scheme or contact your doctor, pharmacist, or nurse. This information is intended as a summary for general awareness and does not replace professional medical advice. 

The information provided in the side effects section is not a comprehensive list of all possible side effects associated with this medication. For a complete list of side effects, please refer to the Patient Information Leaflet (PIL) provided with your medication or consult your healthcare professional[2].

Frequently asked questions about sodium valproate

Is sodium valproate safe during pregnancy? 
No, it can cause serious birth defects and developmental problems[1]. 

Can I drink alcohol while taking sodium valproate? 
Best to avoid alcohol – it may increase drowsiness and seizure risk and increase the risk of liver problems[1]. 

Will sodium valproate affect my fertility? 
It may affect sperm in men (may be reversible on stopping treatment or on dose reduction) and menstrual cycles in women[1]. 

Can I drive while taking sodium valproate? 
If you feel tired or dizzy after taking sodium valproate or after dose increases, do not drive. If you have epilepsy, you must not drive until you have had no seizures for a year, speak to your doctor for advice if need to stop driving[1]. 

What monitoring is needed? 
BMI plus regular blood tests to check liver function and full blood count[1]. 

For the official NHS guide to sodium valproate, visit their website.