Sodium valproate


1. About sodium valproate

Sodium valproate is used to treat epilepsy and bipolar disorder.

It's occasionally used to prevent migraine headaches.

This medicine is only available on prescription. It comes as capsules, tablets and a liquid that you swallow. It also comes as granules that you mix with food or drink.

Sodium valproate can also be given by injection, but this is usually only done in hospital.

If taken during pregnancy, sodium valproate can cause problems for a baby's development, including birth defects and long term learning difficulties. For this reason, sodium valproate is not recommended if there's a chance that you could become pregnant.

For women and girls of childbearing age, if you do need to take sodium valproate then your doctor will put you on Prevent, the valproate pregnancy prevention programme.

Valproate pregnancy prevention programme

The valproate pregnancy prevention programme is very important and is still running during the coronavirus (COVID-19) pandemic.

You should be reviewed every year by your doctor or nurse who will talk to you by video or phone call if you cannot attend your surgery in person. They will assess whether you need to continue taking sodium valproate or whether it is possible to change your medicine.

If you do need to continue sodium valproate then you must be using reliable contraception, even if you are not currently sexually active. Your doctor or nurse can advise you about reliable contraception. You will be asked to sign a form to say that you are using contraception and understand the risks of becoming pregnant while taking sodium valproate.

It's important to get advice as soon as possible if you think you are pregnant or might become pregnant while taking sodium valproate. However, do not stop taking your medicine suddenly without talking to your doctor first.

Updated: 24 August 2021


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3. Key facts

  • You'll usually take sodium valproate once or twice a day. You can take it with or without food.
  • You'll usually start on a low dose. Your dose will gradually increase over a few days or weeks.
  • Valproic acid and semisodium valproate are similar to sodium valproate and work in the same way. However these medicines are used to treat different conditions and doses will vary.
  • There are also brands such as Epilim Chrono, Epilim Chronosphere and Dyzantil which contain mostly sodium valproate, with some valproic acid.
  • If you're pregnant, or there's a chance you could become pregnant, sodium valproate is not recommended for treating migraine. For epilepsy and bipolar disorder, your doctor will only prescribe sodium valproate for you if there are no other suitable treatments.

4. Who can and cannot take sodium valproate

Sodium valproate can be taken by adults and children to treat epilepsy or bipolar disorder.

It can be taken by adults (aged 18 and above) to help prevent migraine.

Sodium valproate is not suitable for girls or women who could become pregnant. However, in some cases it may be the only treatment option available, for example for epilepsy where other treatments have not worked. Girls and women who need to take sodium valproate must be on Prevent, the valproate pregnancy prevention programme.

To make sure sodium valproate is safe for you, tell your doctor if you:

  • have ever had an allergic reaction to sodium valproate or any other medicine
  • have liver problems
  • have a rare metabolic or genetic illness such as porphyria, urea cycle disorder or mitochondrial disorder

5. How and when to take sodium valproate

Sodium valproate is a prescription medicine. It's important to take it as your doctor tells you.

Dosage

The usual dose for treating epilepsy in:

  • adults and older children (aged 12 years and over) – 600mg to 2,000mg a day, as 1 dose or split into 2 doses. Some people take a higher dose of 2,500mg a day
  • younger children (aged 1 month to 11 years) – the doctor will use your child's weight to work out the right dose for them

The usual dose for treating bipolar disorder in:

  • adults – 750mg to 2,000mg a day, as 1 dose or split into 2 doses
  • children – the doctor will work out the right dose for your child

The usual dose for preventing migraine in:

  • adults – daily doses vary from a single dose of 400mg to 1,500mg split into 2 doses

If your doctor tells you to take sodium valproate twice a day, you'll usually take half the dose in the morning and half in the evening (to make up your full daily dose).

If you're taking sodium valproate and have kidney problems, your doctor may prescribe a lower dose.

How to take it

Sodium valproate comes as slow release (prolonged or sustained release) tablets, capsules and granules, gastro-resistant tablets, crushable tablets, and as a liquid.

Slow release medicine passes into your body gradually.

Gastro-resistant tablets release the medicine as soon as it passes through your stomach. This means the sodium valproate is less likely to upset your stomach.

You can take sodium valproate with or without food, but it's best to stick to the same way each time. Do not take it with food some days and without food on other days.

How to take slow release tablets and capsules

Swallow these whole with a drink of water or juice. Do not chew them.

You'll usually take them once a day, unless you're on a high dose and your doctor tells you to take your medicine twice a day.

How to take slow release granules

Add the granules to a small drink, then stir and swallow it. If you prefer, sprinkle the granules onto any soft food that you can swallow whole. Do not chew the granules.

Your doctor will tell you to take these either once or twice a day.

How to take gastro-resistant tablets

Swallow these whole with a drink of water or juice. Do not chew them.

You'll usually take these twice a day.

How to take crushable tablets

Crush the tablets using the back of a spoon and mix the powder with some soft food that you can swallow whole. If you prefer, add the powder to a small drink, then stir and swallow it.

You'll usually take this medicine twice a day.

How to take liquid

Use the plastic syringe or spoon that comes with your medicine to measure the correct dose. If you do not have one, ask your pharmacist. Do not use a kitchen teaspoon as you will not get the right amount.

You'll usually take the liquid twice a day.

When to take sodium valproate

If you're taking sodium valproate once a day, you can choose a time that suits you. Just try to keep to the same time every day.

If you're taking sodium valproate twice a day, try to leave a gap of 10 to 12 hours between doses. For example you could take your first dose in the morning (between 7am and 8am) and your second dose in the evening (between 7pm and 8pm).

Will my dose go up or down?

To reduce the chance of side effects, your doctor will start you off on a low dose of sodium valproate. They will increase it gradually over a few days or weeks.

Once you find a dose that suits you, it will usually stay the same, unless your condition changes, or your doctor starts you on a new medicine that may affect sodium valproate.

What if I forget to take it?

If you've missed a dose, what you do next depends on whether you usually take your medicine once or twice a day.

If you take sodium valproate:

  • once a day – take the forgotten dose as soon as you remember unless it's within a few hours of the next dose. In this case, skip the missed dose and take your next dose at the usual time
  • twice a day – take the forgotten dose as soon as you remember unless it's within 2 hours of the next dose. In this case, skip the missed dose and take your next dose at the usual time

Never take 2 doses at the same time. Never take an extra dose to make up for a forgotten one.

If you have epilepsy, it's important to take this medicine regularly. Missing doses can trigger a seizure.

If you often forget doses, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.

What if I take too much?

Taking too much sodium valproate can lead to symptoms such as:

  • feeling or being sick (nausea or vomiting)
  • headaches or feeling dizzy
  • muscle weakness
  • breathing problems
  • feeling confused, or changes to your normal behaviour
  • passing out

6. Side effects

Like all medicines, sodium valproate can cause side effects, although not everyone gets them.

Common side effects

These common side effects may happen in more than 1 in 100 people. They're usually mild and go away by themselves.

Keep taking the medicine but talk to your doctor if these side effects bother you or do not go away:

  • stomach pain, feeling or being sick
  • diarrhoea
  • dry or sore mouth, or swollen gums
  • shakes (tremors) in a part of your body, or unusual eye movements
  • feeling tired or sleepy
  • headache
  • weight gain
  • thinning hair, or changes to the colour or texture of your hair
  • irregular or delayed periods

Serious side effects

It's unusual to have serious side effects after taking sodium valproate. Tell a doctor straight away if you have:

  • thoughts of harming or killing yourself – a small number of people taking sodium valproate have had suicidal thoughts
  • yellowing of the whites of your eyes or your skin, although this may be less obvious on brown or black skin, and dark pee – these may be signs of liver problems
  • long-lasting and severe nausea, vomiting or stomach pain – these may be signs of acute pancreatitis (an inflamed pancreas)
  • unusual bruises or bleeding – these may be signs of a blood disorder

Serious allergic reaction

In rare cases, sodium valproate may cause a serious allergic reaction (anaphylaxis).

These are not all the side effects of sodium valproate. For a full list, see the leaflet inside your medicine packet.


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8. How to cope with side effects of sodium valproate

What to do about:

  • stomach pain, feeling or being sick – take sodium valproate with or after a meal or snack. It may also help if you avoid rich or spicy food. Take small, frequent sips of water if you're being sick to avoid dehydration.
  • diarrhoea – drink plenty of fluids such as water or squash to avoid dehydration. Speak to a pharmacist if you have signs of dehydration, such as peeing less than usual or having dark, strong-smelling pee. Do not take any other medicines to treat diarrhoea without speaking to a pharmacist or doctor.
  • dry or sore mouth, or swollen gums – for a dry mouth try sugar-free gum or sweets, or sipping cold drinks. If this does not help, or you have mouth ulcers, talk to your pharmacist or doctor. If you're bothered by swollen gums or this symptom does not go away, talk to your doctor or dentist.
  • shakes (tremors) in a part of your body, or unusual eye movements – talk to your doctor if this is bothering you. These symptoms can be a sign that your dose is too high. Talk to your doctor as they may want to change your dose or suggest you take it at a different time.
  • feeling tired or sleepy – as your body gets used to sodium valproate, these side effects should wear off. If these symptoms do not get better within a week or two, your doctor may either reduce your dose or increase it more slowly. If that does not work, talk to your doctor as they may want to switch you to a different medicine.
  • headaches – make sure you rest and drink plenty of fluids. Try not to not drink too much alcohol. Ask your pharmacist to recommend a painkiller. Talk to your doctor if your headaches last longer than a week or are severe.
  • weight gain – if you find you're putting on weight after taking sodium valproate, try to have a healthy balanced diet. Regular exercise will also help you keep your weight stable. Your doctor will usually monitor your weight while you're taking this medicine. Speak to them if you have any concerns.
  • thinning hair, or changes to the colour or texture of your hair – if these symptoms bother you, ask your doctor whether it's possible to lower your dose. Your hair may regrow after either reducing your dose or switching to a different medicine.
  • irregular or delayed periods – if you usually have regular periods, take a pregnancy test if your period is late, and speak to your doctor if the result is positive. As well as being a side effect of sodium valproate, a late period is a sign that you could be pregnant, and sodium valproate can be harmful for an unborn baby. Changes to your periods can also be a symptom of polycystic ovary syndrome (PCOS), a rare side effect of sodium valproate. Your doctor will be able to do some tests to check whether you have PCOS.

9. Pregnancy and breastfeeding

Sodium valproate is not recommended in pregnancy, as it can cause birth defects and problems with your baby's learning and behaviour.

If there's a chance you could become pregnant while taking this medicine, your doctor will put you on Prevent, the valproate pregnancy prevention programme.

If you think you might already be pregnant, contact your doctor or nurse as soon as possible.

If you're taking sodium valproate for epilepsy or bipolar disorder and you become pregnant, do not stop taking your medicine without talking to your doctor first. This is because your symptoms may get worse.

Your doctor may continue to prescribe sodium valproate, but only if there's no other suitable treatment for your epilepsy or bipolar disorder.

For pregnant women with recurrent migraine your doctor should offer you an alternative treatment to sodium valproate.

Information:

You must have a review of your treatment every year. Contact your doctor or specialist now if you have not had one.

If your doctor or health visitor says your baby is healthy you can take sodium valproate while breastfeeding.

Sodium valproate passes into breast milk in small amounts but it's unlikely to harm your baby so you can continue breastfeeding if your doctor says you need to take it.

If there's a chance you could become pregnant while taking this medicine, your doctor will put you on Prevent, the valproate pregnancy prevention programme. Your doctor may still recommend sodium valproate if it is the only medicine that works for you.

Do not stop taking your medicine without talking to your doctor first as your symptoms may get worse. Breastfeeding will also benefit both you and your baby.

Talk to your health visitor, midwife, pharmacist or doctor as soon as possible if:

  • your baby is not feeding as well as usual
  • your baby is bruising more easily than usual
  • the whites of your baby's eyes turn yellow or your baby's skin turns yellow (this may be less obvious on brown or black skin), or your baby has dark pee or pale poo – these can be signs of jaundice

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11. Cautions with other medicines

There are some medicines that may affect how sodium valproate works. Sodium valproate can also affect the way other medicines work.

Tell your doctor if you're taking any of these medicines:

Mixing sodium valproate with herbal remedies or supplements

It's not possible to say whether complementary medicines and herbal supplements are safe to take with sodium valproate.

They're not tested in the same way as pharmacy and prescription medicines. They're generally not tested for the effect they have on other medicines.


12. Common questions about sodium valproate

Page last reviewed: 24/08/2021
Next review due: 24/08/2024