Prescribing Notes
- Therapy should be initiated by a psychiatrist and only following medical examination and careful assessment of risk/benefit
- See NICE CG 185 Bipolar disorder.
- Valproate must not be started in new patients (male or female) younger than 55 years, unless two specialists independently consider and document that there is no other effective or tolerated treatment, or there are compelling reasons that the reproductive risks do not apply. For the majority of patients, other effective treatment options are available. See MHRA.
- The Lithium Shared Care Guideline should be consulted for advice on appropriate patient management including monitoring requirements and responsibilities.
Those of childbearing potential
- Women receiving mood stabilisers must be warned to obtain pre-conception advice if they plan to become pregnant; the risk of relapse following withdrawal of mood stabilisers must be balanced against their established teratogenic potential which should be fully discussed with the patient. Psychiatric advice should be sought regarding the most appropriate management of individual patients. Advice is normally weighted towards stopping mood stabilisers and maintaining the patient on an antipsychotic if necessary.
- Use of valproate in women and girls of childbearing potential who cannot be treated with other medicines must be in accordance with the Pregnancy Prevention Programme. See MHRA. (Note: Valproate must not be prescribed in bipolar patients who are pregnant).
- As a precaution, MHRA recommend that male patients use effective contraception (condoms, plus contraception used by the female sexual partner) throughout the valproate treatment period and for 3 months after stopping valproate. See MHRA for further information.