Valproate
NICE recommends valproate as a first-line option for the treatment of people who develop acute mania.
Valproate is available in the following three forms:-
This gets a bit confusing as semi-sodium valproate (aka Depakote) is actually an equimolar mix of sodium valproate and valproic acid.
Note this is from the BNF 61 and is not consistent with the Maudsley Guidelines 10th Edition which suggest valproic acid is not licensed for acute mania.
Be aware that doses of sodium valproate and semi sodium valproate are not the same. A slightly higher dose (approx 10%) is required if sodium valproate is used. This is due o the fact that valproate semi-sodium 500 mg tablets contain 15.5% more valproic acid equivalent than sodium valproate 500 mg tablets.
Adverse effects
Valproate is associated with many adverse effects the most important ones to be aware of include:-
Teratogenic effects
Valproate is a teratogen and so should not be initiated in women of childbearing potential.
Valproate is available in the following three forms:-
- Semi-sodium valproate (licensed for acute mania associated with bipolar disorder)
- Valproic acid (licensed for acute mania associated with bipolar disorder)
- Sodium valproate (licensed for epilepsy)
This gets a bit confusing as semi-sodium valproate (aka Depakote) is actually an equimolar mix of sodium valproate and valproic acid.
Note this is from the BNF 61 and is not consistent with the Maudsley Guidelines 10th Edition which suggest valproic acid is not licensed for acute mania.
Be aware that doses of sodium valproate and semi sodium valproate are not the same. A slightly higher dose (approx 10%) is required if sodium valproate is used. This is due o the fact that valproate semi-sodium 500 mg tablets contain 15.5% more valproic acid equivalent than sodium valproate 500 mg tablets.
Adverse effects
Valproate is associated with many adverse effects the most important ones to be aware of include:-
- Tiredness (This is a common side effect that can present with slowing of mental processing speed and less motivation and less spontaneity)
- Significant weight gain (weight gain affects 30% to 50% of people who take valproate)
- Tremor (up to a quarter of patients)
- Hair loss (hair loss occurs in 5% to 10% of people who take valproate. The hair almost always grows back after the valproate is stopped, but it often has a different texture and may grow in curly instead of straight)
Teratogenic effects
Valproate is a teratogen and so should not be initiated in women of childbearing potential.
