Sodium valproate (oral/IV)

Fatty acid derivative·Neurology - Anticonvulsants

Bipolar disorder (mania), all forms of epilepsy (generalised and focal)

Authority requiredPBSMOOD STABEpilim, Epilim CR, Valpro500 mg EC tablet+2

Target Range

350–700 umol/L

Half-life

14 h

Teratogenic

CRITICAL

Hepatic

MONITOR

Rapid Summary

Overview

Broad-spectrum anticonvulsant and highly effective mood stabiliser for Bipolar Mania. Extremely dangerous in women of childbearing age.

Maximum Dose

Max 2500 mg/day (Titrated to response and blood levels).

Clinical Focus

The most teratogenic drug in neurology/psychiatry. Causes horrific birth defects and neurodevelopmental destruction.

Bottom Line

Sodium valproate (oral/IV) is a broad-spectrum anticonvulsant and mood stabiliser, but is absolutely contraindicated in women of childbearing potential due to teratogenicity and requires hepatic and haematological monitoring.

Formulation & Access

Brand Names

Epilim, Epilim CR, Valpro

Oral Routes

Enteric-coated tablets (100, 200, 500 mg). Crushable tablets (100 mg). CR Tablets (200, 500 mg). Oral liquid.

Parenteral

Ampoules (400 mg powder) for IV use.

Prescribing & PBS

Authority Required (PBS). Special consent forms often mandated for females < 50 yrs.

Indications & Use

Primary

PBSTGA

Bipolar disorder (mania), all forms of epilepsy (generalised and focal).

Off-Label

OFF

Migraine prophylaxis.

Clinical Place

First-line for generalized epilepsy in males. First-line for acute bipolar mania.

Quick reference

Class & Role

Fatty acid derivative — Broad-spectrum anticonvulsant and highly effective mood stabiliser for Bipolar Mania.

Route / Formulation

Enteric-coated tablets (100, 200, 500 mg). Crushable tablets (100 mg). CR Tablets (200, 500 mg). Oral liquid. (Epilim, Epilim CR, Valpro)

Usual Dose & Max

Start PO 500 mg BD (enteric-coated or CR). Titrate rapidly to target range. Maintenance 1000-2000 mg/day. Max 2500 mg/day (Titrated to response and blood levels).

Key Indication Doses

Bipolar Mania: Start PO 500 mg BD (enteric-coated or CR). Titrate rapidly to target range. Maintenance 1000-2000 mg/day. Epilepsy: PO Start 400-600 mg/day. Increase until seizures are controlled. Max 2500 mg/day. Status Epilepticus: IV 20-30 mg/kg bolus, then continuous infusion.

Best Uses

Avoid / Cautions

Active liver disease, mitochondrial disorders (POLG mutations), urea cycle disorders. Pregnancy Category D (Functionally Category X). Causes neural tube defects (spina bifida) in 10% of cases, and drops the child's IQ by 10 points. MUST NOT be used in women of childbearing age unless all other options have failed and strict dual-contraception is enforced.

Key Risks

Hepatic: Fatal hepatotoxicity (highest risk in children < 2 years on polytherapy). Hyperammonemic encephalopathy (confusion/coma without elevated LFTs). Haematological: Thrombocytopenia (low platelets), impaired coagulation. Metabolic/GI: Significant weight gain, severe nausea (reduced with CR forms), PCOS-like syndrome, hair loss, pancreatitis.

Key Interactions

Lamotrigine. Valproate completely blocks the clearance of Lamotrigine, doubling its levels and causing fatal SJS/TEN. If combining, Lamotrigine dose must be halved and titrated glacially. Meropenem/Carbapenems. Within 24 hours of starting Meropenem, Valproate levels drop to ZERO. The patient will seize. Avoid combination.

Monitoring

Baseline and routine LFTs, FBC (platelets). Measure TDM (Valproate levels, target 350-700 umol/L). Check Ammonia levels if the patient becomes acutely confused or lethargic (Hyperammonemic encephalopathy).

Clinical Pearl

Doses > 1500mg/day often cause thrombocytopenia. Always check a recent FBC before taking a Valproate patient to surgery, or they will bleed out.

Access

Authority requiredEpilim, Epilim CR, Valpro500 mg EC tablet

Brand: Epilim, Epilim CR, Valpro
PBS status: Authority required
Formulation: Enteric-coated tablets (100, 200, 500 mg)