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Valproate

Valproate ("VAL-pro-ate") is a mood stabiliser and can be used to treat mania. It is also widely used as an anticonvulsant to treat epilepsy (fits)

This page will give you general information about valproate. It is not medical advice. Always talk to your doctor about your situation and whether this medication is for you.

What's it for?

Valproate is licensed to treat the following conditions:

Valproate can also sometimes be prescribed ‘off-label’ for aggressive behaviour in young people aged under 18, though it’s not recommended in national treatment guidance for the UK.

Your doctor should discuss the reasons why they believe this is the right medication for you before you start taking it.

Name: valproate ("VAL-pro-ate")

Other names: Depakote ("DEP-a-coat"), Belvo, Epilim, Episenta, Epival, Convulex, Syonell

Medication type: mood stabiliser

What can it be used for?
Valproate must no longer be used in any woman or girl able to have children unless she has a pregnancy prevention programme in place. This is designed to make sure patients are fully aware of the risks and the need to avoid becoming pregnant. For more information, please read the guidance provided by the Government on the use of valproate by women and girls (link: https://www.gov.uk/guidance/valproate-use-by-women-and-girls)

If you are 18 or over, the doctor can prescribe sodium valproate (as Episenta) or valproate semisodium (as Depakote and other brands) for you as a licensed medicine for mania that occurs with bipolar disorder. All sodium valproate products - but not valproate semisodium - are licensed to treat epilepsy.

Other preparations of sodium valproate (such as the brand Epilim) are very commonly used 'off-label' for mania. This is often due to the fact that liquid forms are available which make for easier swallowing. Valproate is likely to be used longer term to help prevent the return of symptoms of mania, and this is now recognised as within licensed use so long as the product chosen is not just licensed for epilepsy.

Sodium valproate can also be used 'off-label' to treat other conditions such as severe aggression.

Outside of its use in the treatment of epilepsy, there is less research on its effectiveness in young people under 18. Even so, specialists might prescribe it ‘off-label’ if they believe it is the best medicine for you.

Ways to take and what's in it?
Tablets: Valproate semisodium is available as tablets (250mg and 500mg strengths)

Sodium valproate, if used, is available as crushable tablets (100mg strength), gastro-resistant (enteric-coated) tablets (200mg and 500mg) controlled release tablets (200mg, 300mg and 500mg strengths), liquid (sugar-free), syrup (both containing 200mg sodium valproate in 5ml) and granules.

Liquid formulations contain sorbitol and saccharin, while the syrup additionally contains sugar and should be avoided if you have diabetes.

How it works

What does valproate do?

Valproate helps to treat the symptoms of mania (being very excited, overactive, easily irritated or distracted) in people with bipolar disorder. It is also used to prevent these symptoms from coming back.

With bipolar disorder, a person's 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 is a type of medicine called a mood stabiliser as it reduces feelings of excitability and over-activity and reduces mood swings.

Medicines like valproate can keep your mood stable (stop it going too high or too low).

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 create 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, which reduces nerve excitement.

How long does valproate take to start working?

If you are having a manic episode the doctor is likely to increase your dose quite quickly over a few days.

It usually only takes a few days for valproate to start working and to have its best effect.

Your dose is likely to be reduced in the longer term to get the best effect for you. This is because you are unlikely to need the same high dose as you would in a manic episode to provide longer-term benefit.

How long will I need to take valproate?

You will need to take valproate for several months after you feel better, otherwise your symptoms can come back.

Your doctor will advise you how long you'll need to stay on valproate, as it depends on what you are taking it for. If you are taking it to prevent the symptoms of mania from coming back, it might be about six months.

If you stop taking the valproate too soon, there is more chance that your symptoms will come back.

Your doctor needs to know if...

You need to talk to your doctor or pharmacist before starting treatment with valproate if any of the following apply to you:

  • you currently have liver problems
  • you or someone in your family has ever had serious liver problems related to medicines
  • you have systemic lupus erythematosus (an inflammatory condition also called lupus or SLE)
  • you have a rare illness called porphyria which affects your metabolism
  • you are trying to get pregnant

Taking valproate

You should only take valproate as agreed with your doctor

You will get the 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 with your pharmacist or doctor.

Valproate semisodium 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 need 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 you should drink this water 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 and would otherwise need to take doses 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 the tablet from stomach acid. 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 if I miss a dose?

If you remember later during the day, take it as soon as you remember - unless you are less than four hours away from your next dose. If you forget to take it by then, just start again with the next dose.

Do not take a double dose.

What will happen if I forget to take my valproate?

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.

Stopping the use of valproate

Once you start taking valproate, the brain adjusts to having its calming effect. If you stop taking the valproate all at once, the chemical balance in your brain starts to change again, meaning you could get your old symptoms back.

However, you can stop taking valproate safely with your doctor’s help.

Go and speak to your doctor if you have missed a few doses or have decided to stop taking your medication.

When you agree with your doctor to stop the medicine, you will carry on with a dose that gradually decreases over about a month.

The information on this page was reviewed by the College of Mental Health Pharmacy in March 2020.

CMHP
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