ValproateReturn to Valproate overview
If I could go back in time to before I started taking meds, I would tell myself to persevere as things will get better, even if it doesn’t feel that way.
Valproate can be used to treat the following conditions
Headmeds fills the medicines information gaps for young people - things you might want to know about meds like will it affect my sex life? Can I still study? Can I drink?
Headmeds does not give medical advice so this is just general information.
Each medicine has a balance of good and bad effects, and each person gets their own individual effects.
You might want to know just one thing about your medicine, but on each page we have given you the ‘safety headlines’. Please read them as they are important.
We have included lots of information about each medicine - but if you want all the details, please look at the patient information leaflet - which is inside every pack. These leaflets are also at www.medicines.org.uk - where there will be the most up-to-date information. Please be aware that the leaflets will only refer to the licensed use for your medicine. The leaflet will not mention any 'off label' use - this includes off-label conditions and also 'off label age groups.
- If you have taken more valproate than it said on the label, you must see a doctor quickly – even if you do not feel any different.
- Valproate can make some people think about hurting themselves or committing suicide. You must go straight to hospital with your tablets if you have any of these thoughts.
- Valproate can sometimes cause other rare but serious side-effects: allergic reactions (difficulty breathing, swelling of your face or throat, itching skin lumps), problems with your liver or pancreas (suddenly feeling weak, not wanting to eat, feeling sleepy or confused, severe stomach pain, feeling or being sick, or the whites of your eyes changing to yellow) and problems with your blood cells (which might show as bruising, getting more infections than usual, a sore throat, feeling weak, tired, dizzy or having very pale skin). Go to a hospital if you get any of these symptoms and take your medicine with you.
- Stopping valproate suddenly can cause symptoms to return - if you are thinking of stopping or want to stop, talk to your doctor first.
- You might feel sleepy in the first few days after taking valproate - do not drive a car, ride a bike or operate machines until you see how this affects you.
If you are pregnant, or thinking of becoming pregnant, please read the pregnancy section (see “Sex, drink, weight and everything else”) because valproate may affect the developing baby. Valproate can cause serious harm to a developing baby and should no longer be prescribed to women and girls who are able to have babies unless they are on the Valproate Pregnancy Prevention Programme (Prevent).
Valproate is available as three slightly different compounds, each licensed for different conditions, but sometimes also used 'off label':
- ‘valproate semi-sodium’,
- ‘sodium valproate’ and
- 'valproic acid'.
Your body turns valproate semi-sodium and sodium valproate into valproic acid.
Valproic acid (brand name Convulex) is normally only used to treat epilepsy.
Valproate semi-sodium (brand name Depakote) is normally only used to treat mania and to prevent return of symptoms.
Sodium valproate is used for the treatment of epilepsy as well as "off label’ in the treatment of mania and to prevent return of symptoms. There are several different drug companies that make sodium valproate. Brand names include Epilim and Episenta.
Valproate is a mood stabiliser
- Valproate is a medicine called a ‘mood stabiliser’ as it reduces feelings of excitability and over-activity and reduces mood swings.
- Having these types of symptoms can interrupt your day to day life.
- Medicines like valproate can keep your mood stable (stop it going too high or too low).
- Valproate has also been used 'off label' to treat aggressive behaviour.
Valproate can be used to help with mania and bipolar disorder
- Valproate helps to treat the symptoms of mania (very excited, overactive, easily irritated or distracted) in bipolar disorder. Valproate is also used to prevent those symptoms from returning. In bipolar disorder your mood changes from very high (mania) to very low (depression). Valproate is less effective at preventing the symptoms of depression in bipolar disorder from returning, but there are other medicines that can help with this.
- Valproate may also be used to help with other conditions where there are mood swings.
Are the tablets and capsule suitable for everyone?
- Valproate prolonged release capsules (Episenta) contain gelatine and may not be suitable if you don’t eat meat.
- Valproate semi-sodium tablets 250mg strength contains a colour called sunset yellow (also called E110) that might cause an allergic reaction in some people. Talk to your pharmacist or doctor if you are allergic to any food additives.
Valproate can help to calm down the brain
- We do not fully understand how valproate works for mania and bipolar disorder, but we have some ideas about it.
- Valproate blocks the breakdown of a chemical in the brain called gamma-aminobutyric acid (GABA). GABA is a chemical that calms nerve excitability in the brain. If valproate blocks its breakdown, there is more GABA to make this calming effect.
- There are gateways in the brain called ‘sodium channels’, which can be open or closed. When they are open, chemicals go through that can make us excited.
- Valproate may also work by locking on to closed sodium channels, and keeping them closed. Sodium cannot pass through and this reduces nerve excitement.
You should take valproate as agreed with your doctor
- You will get most benefit from your valproate if you take it every day.
- Make sure that you know your dose. If it is not written on the label, check it with your pharmacist or doctor.
- Valproate semi-sodium is normally taken twice a day but sometimes it may be three times a day.
- The starting dose is normally 750mg per day but will probably be increased to between 1000mg and 2000mg a day.
- Sodium valproate is available as ‘controlled release’ (also called ‘prolonged release’) tablets, capsules and granules that mean you only have to take it once a day. The controlled release capsules or tablets should be swallowed whole with a glass of water and not crushed or chewed. The controlled release granules can either be sprinkled on a small amount of soft cold food, taken in a drink, or poured directly into the mouth and washed down with a cold drink. If the granules are added to a drink, after you’ve had the drink the glass should be rinsed with a small amount of water and this water should be taken as well, as some granules may stick to the glass. The granules should not be crushed or chewed.
- Controlled-release medicines might help you if you find it difficult to remember all the doses, or have to take it at school, university or work.
- Valproate can be taken with or after a meal. Taking it with food can help to reduce the chance of feeling sick. Not everyone feels sick with valproate but this is one of the possible side effects.
Some of the valproate preparations have a special coating (“enteric” or “gastro-resistant” coating) to protect your stomach. This tablet should be swallowed whole with a glass of water - do not chew it as it tastes bitter and you will break the protective coat.
What should I do if I forget to take a dose of valproate?
What to do if you miss a dose:
- If you remember later during the day, take it as soon as you remember - unless you are less than 4 hours away from your next dose.
- If you forget to take it by then, just start again on the next dose.
- Do not take a double dose.
What might happen?
- If you forget to take it for a few days, you may start getting your symptoms back and should talk to your doctor about it.
How long will it take valproate to start working?
- Your doctor will start with a low dose that increases to a dose that is effective for you. This may take several days or weeks.
- It usually only takes a few days for valproate to start working and to have its best effect.
- Your dose may need to be changed to get the best effect for you.
- To get the best effect, you need to take your valproate every day and give it a chance to work for you.
- You will need to take valproate for several months after you feel better - otherwise your symptoms can come back.
- Keep taking valproate as you get better, which can take a few months, and then keep taking it. Your doctor will advise you how long as it depends on what you are taking the valproate for. For preventing the symptoms of mania from coming back it might be about 6 months.
- If your illness has come back, then you might be advised to keep taking valproate for longer than this.
- This will help keep you well. If you stop taking the valproate too soon, there is more chance that your mental health symptoms will come back.
- Discuss with your doctor how long you should take valproate for.
Search https://www.medicines.org.uk/emc to find patient information leaflets and prescribing information on valproate. Tablets in their different presentations, capsules and liquid are listed separately and many include a useful brand name. The SmPC lists all the inactive ingredients in the product so you can check against any allergies. If you are still unsure about this then speak to your pharmacist.
- British National Formulary (BNF) and British National Formulary for children. Download the BNF/BNFC app (blue background) on to your mobile device. No longer available for public access via the web
- Taylor D, Barnes T, Young A. Maudsley Prescribing Guidelines in Psychiatry, 13th edition. Oxford: John Wiley & Sons, May 2018. ISBN: 978-1-119-44260-8
- Royal Pharmaceutical Society. Medicines Ethics and Practice (42nd edition). London: RPS, 2018. Standards for pharmacists to work to. It is not a free publication
- World Anti Doping Agency WADA Prohibited List https://www.wada-ama.org/en/resources/science-medicine/prohibited-list-documents
- Choiceandmedication; an independent source of information on many mental health conditions and their medicines with easy to read fact sheets www.choiceandmedication.org Personal subscriptions to download the app available for £1 per month (with proportionate discounts for longer periods) but your local mental health Trust may subscribe and provide information sheets for free.
- Best Use of Medicines in Pregnancy (BUMPS). Information sheets on drugs in pregnancy http://www.medicinesinpregnancy.org/
- Drugs and Lactation Database (LactMed). Information on drugs in breastfeeding https://toxnet.nlm.nih.gov/newtoxnet/lactmed.htm
- NICE. Bipolar disorder: assessment and management Clinical Guideline 185, Sept 2014 (last updated April 2018) https://www.nice.org.uk/guidance/cg185
- British Association of Psychopharmacology. Evidence based guidelines for treating bipolar disorder. Journal of Psychopharmacology 2016. Available at: https://www.bap.org.uk/pdfs/BAP_Guidelines-Bipolar.pdf
- Valproate use by women and girls. MHRA Guidance updated December 2018 https://www.gov.uk/guidance/valproate-use-by-women-and-girls#patient-information-leaflets