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Mood stabiliser / Antiepileptic Pregnancy: CONTRAINDICATED in pregnancy unless absolutely no alternative. See neurology entry.

Sodium Valproate (Psychiatric use)

Brand names: Epilim, Depakote (valproic acid), Episenta

Adult dose

Dose: Acute mania: 250 mg three times daily, increasing to 1000–2000 mg/day; Maintenance: 1000–2000 mg/day
Route: Oral
Frequency: Twice daily (standard) or once daily (modified-release)
Max: 2500 mg/day
Acute mania: 250 mg TDS, increasing rapidly. Target serum level 50–100 mg/L. Modified-release preparations preferred (better tolerability). Valproate Pregnancy Prevention Programme mandatory — see neurology entry for full details. MHRA alert — not for women of childbearing potential without VPPP compliance.

Paediatric dose

Dose: 10 mg/kg
Route: Oral
Frequency: Twice daily
Max: Specialist guidance required for paediatric psychiatric use
Not licensed for mania/bipolar in children in UK. Specialist guidance required. MHRA alert applies equally to paediatric female patients.

Dose adjustments

Renal

No specific dose adjustment but monitor levels.

Hepatic

Contraindicated in hepatic impairment.

Paediatric weight-based calculator

Not licensed for mania/bipolar in children in UK. Specialist guidance required. MHRA alert applies equally to paediatric female patients.

Clinical pearls

  • MHRA (2023): Patient and healthcare professional cards — both must sign annual review form for VPPP
  • High teratogenicity risk (11% major malformations, 30–40% neurodevelopmental effects in offspring)
  • Alternative mood stabilisers in women of childbearing age: lithium, quetiapine, lamotrigine (limited evidence for acute mania)
  • Monitor serum levels (50–100 mg/L) for bipolar treatment

Contraindications

  • Hepatic impairment
  • Pregnancy (unless no alternatives — VPPP)
  • Women of childbearing potential without effective contraception and VPPP enrolment
  • Mitochondrial disorders
  • Porphyria

Side effects

  • See neurology entry: nausea, weight gain, tremor, hair loss, hepatotoxicity, pancreatitis, teratogenicity
  • Polycystic ovary syndrome features

Interactions

  • See neurology entry: carbapenems, lamotrigine, warfarin
  • Olanzapine — increased QT and sedation risk

Monitoring

  • Serum valproate levels
  • LFTs
  • Weight
  • Pregnancy status (all women of childbearing potential)

Reference: BNFc; BNF; MHRA Valproate Safety Alert 2023; NICE NG185. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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