Antiepileptic / mood stabiliser
Valproic acid
Brand names: Convulex, Depakote, Episenta
Adult dose
Dose: Initial 600mg PO/day in 1-2 doses, increase by 200mg every 3 days; usual 1-2g/day (max 2.5g/day)
Route: PO/IV
Frequency: OD-BD
Clinical pearls
- Generalised/focal epilepsy, bipolar disorder
- MHRA: Pregnancy Prevention Programme mandatory for women under 55; men aged <55 — separate PPP introduced 2024
Contraindications
- Pregnancy / women of childbearing potential without PPP (MHRA — black box)
- Severe hepatic impairment
- Mitochondrial disease (POLG)
- Urea cycle disorders
- Acute porphyria
- Hypersensitivity
Side effects
- Hepatotoxicity (severe — boxed)
- Pancreatitis
- Teratogenicity (high)
- Thrombocytopenia
- Hyperammonaemia
- Weight gain
- Hair loss
- Tremor
Interactions
- Many — strong enzyme inhibitor
- Lamotrigine (raises levels — slow titration)
- Carbapenems (avoid — drop levels)
- Aspirin
Monitoring
- LFTs
- FBC
- Pregnancy
- Drug levels (selected)
Reference: BNF; NICE NG217; MHRA; https://bnf.nice.org.uk/drugs/valproic-acid/. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Calculators
- Cornell Scale for Depression in Dementia (CSDD) · Mood
- Tumor Lysis Syndrome Risk (Cairo-Bishop) · Oncological Emergency
- Young Mania Rating Scale · Diagnosis
- Mood Disorder Questionnaire (MDQ) · Bipolar Screening
- DSM-5 Criteria for Bipolar Disorder · Mood Disorders
- Calgary Depression Scale for Schizophrenia (CDSS) · Mood
Pathways
- Acute Stroke / TIA Assessment · NICE NG128; RCP Stroke Guidelines 2023
- Status Epilepticus (Adults) · NICE CG137; ESEM guidelines; RCP Neurology Guidelines
- Suspected Subarachnoid Haemorrhage · NICE NG228; RCEM 2023; AHA/ASA 2023
- Adult Head Injury · NICE NG232 (2023)
- Bell's Palsy / Facial Nerve Palsy · ENT UK 2017; AAN
- Vertigo Workup · ENT UK; NICE CKS