Sodium Valproate (Paediatric — Epilepsy)

How it works

It raises brain GABA concentrations and modulates voltage-gated sodium and calcium channels, reducing neuronal excitability and seizure activity.

Prescribing in practice

• Valproate is highly teratogenic and is contraindicated in girls and women of childbearing potential unless the conditions of the MHRA Pregnancy Prevention Programme are met, so its use in female children must anticipate this and prompt specialist review around adolescence.
• Idiosyncratic hepatotoxicity (greatest risk in young children and those with metabolic or mitochondrial disorders) and pancreatitis can occur, sometimes early in treatment.
• Doses are weight-based and titrated; confirm against a children's formulary and avoid abrupt withdrawal.

Monitoring

Check baseline liver function and full blood count and remain alert to symptoms of liver dysfunction, pancreatitis or bleeding, with level measurement reserved for specific clinical questions rather than routine titration.

Counselling the patient

• Seek urgent help for vomiting, abdominal pain, drowsiness, jaundice or unusual bruising.
• Do not stop the medicine suddenly.
• For female patients, discuss pregnancy-prevention requirements with the specialist before reaching childbearing age.

Evidence & guidelines

MHRA safety regulation restricts valproate in females of childbearing potential to a Pregnancy Prevention Programme owing to high risks of congenital malformation and neurodevelopmental disorders.