Patient Information Centre

Stamford Building (lower ground floor)

Tameside General Hospital
Fountain Street
Ashton-under-Lyne
OL6 9RW
Tel: 0161 331 5332
Email: Infopatient@tgh.nhs.uk
Website: www.tamesidehospital.nhs.uk/infopatient/infoHome.htm
The centre is open between the hours of 9.00 am and 5.00 pm from
Treatments for mood disorder
Monday to Friday. Outside these hours, you can leave a message on (Drugs known as mood stabilisers)
the telephone voicemail service or you can email. Please do not Sodium valproate, valproic acid and
forget to leave your contact details so that the centre can answer valproate semisodium
your enquiry as soon as possible.

Information contained in this leaflet has been adapted from the Patient Information Leaflets
developed by Norfolk and Waveney Mental Health Partnership NHS Trust. This information has
been included with the kind permission of Stephen Bazire, Chief Pharmacist, Norfolk and
Waveney Mental Health Partnership NHS Trust.

Forms available
Drugs Tablets Capsules Liquid Injection
Sodium valproate ✓ ✓ ✓
Valproate ✓
semisodium
Date of publication: Jan/06
Ref: 122AP/Central/CNST
Valproic acid ✓
© Pennine Care NHS Trust

(Also anticonvulsant for treatment of epilepsy)

Sodium valproate, valproic acid and valproate semisodium (sometimes
also called divalproex) are different forms of the same drug. They are
virtually the same and so, on these pages, all the information refers
to just valproate, which applies exactly the same to the other forms
as well. Valproate semisodium may have slightly less side effects at
the high doses needed when someone is manic.
What is valproate used for?
Valproate has two main uses. Firstly as a treatment for epilepsy, to
help control the fits (seizures or blackouts). Secondly, to help in mood
disorders, especially if the person is suffering from mania or
hypomania i.e. is ‘high’) and as a longer-term mood stabiliser (and
alternative to lithium and carbamazepine). Valproate may also be
useful in some other illnesses, particularly when other treatments
have not been effective.
How does valproate work?
It is not entirely clear exactly how valproate works (both as a mood
stabiliser and as an anticonvulsant) as it does several things in the
brain. Firstly, there is a chemical messenger (or ‘neurotransmitter’) in
the brain called GABA, which is ‘inhibitory’ on the brain i.e. it calms
the brain down. Once it has worked there are other chemicals (or
‘enzymes’) in the brain which are there to break GABA down so that
it can no longer work. In people with normal levels of GABA this
prevents there being too much GABA. In some people it is thought
that there may not be enough GABA in the brain. This lack of GABA
seems to ‘trigger’ fits or over-activity/mania. Valproate helps to stop
the breakdown of GABA and so leaves enough of this chemical in the
brain to help prevent the fits, blackouts and over-activity. Secondly, it
may inhibit ‘repetitive firing’ of neurones. When a message is passed,
there is a short ‘refractory’ period or gap before the next message
can be passed, during which time the nerve ending re-sets itself
(about one thousandths of a second). Valproate may increase this
2 3
‘refractory’ period or time by a small amount. Under normal
circumstances, this will make no difference at all, but if the brain is
overactive and lots of messages are being passed in quick succession
e.g. when you are feeling high, the effect of the valproate will be to
slow the number of messages back to the normal level e.g. if the next
message follows along before the nerve has reset itself, the message
can’t be passed.
How should I take them?
Tablets:
The tablets should be swallowed with at least half a glass of water
whilst sitting or standing, so that they reach your stomach and do not
stick in your throat.
It is especially important that you swallow ‘enteric coated’ tablets or
capsules (all except the 100mg ‘Epilim’) whole and do not crush or
chew them. The coating helps to prevent any stomach upsets that
could occur. Crushing or chewing will cause the drug to be released
too soon and you may get some side effects. Sodium valproate tablets
which are not enteric coated (i.e. ‘Epilim’ 100mg) may be crushed if
necessary.
Taking fizzy drinks (e.g. colas) with the 100mg tablets and syrups may
lead to more stomach upsets. If this happens, it may be best not to
drink too many fizzy drinks.
Liquids
Sodium valproate is available as a syrup and as a sugar free liquid.
Your pharmacist should give you a medicine spoon or oral syringe.
Use it carefully to make sure you measure the correct amount. Ask
your pharmacist for a medicine spoon if you do not have one.
If it is necessary for you to have an injection it will be given by a
nurse or doctor.
When should I take my valproate? What should I do if I forget to take a dose?
Take it as directed on the medicine label. It is best to take valproate Start again as soon as you remember unless it is almost time for your
after food. It is particularly important to take this regularly as next dose, then go on as before. Do not try to catch up by taking two
directed by your doctor to make sure that you are getting the best or more doses at once as you may get more side effects. If you are ill
control from your medication. Missing a dose can cause your fits to and vomit after taking your valproate, you should take that dose
return. again. You should tell your doctor about either of these next time you
meet. Missing a dose can cause your fits to return. The amount in
How long will valproate take to work? your blood may drop below the level needed to control your fits. If
Valproate should start to work soon after you start to take it. It may, you have problems remembering your doses (as very many people do)
however, take some time for your doctor to get the right dose for ask you pharmacist, doctor or nurse about this. There are some special
you. If you take valproate for epilepsy, the aim is for the amount of packs, boxes and devices which can be used to help you remember.
medicine in your blood to be high enough to prevent or reduce fits,
but low enough to give you the least amount of side effects. Do not What sort of side effects might occur?
attempt to make any changes yourself unless specifically told to do so.
Side effect What happens What to do about it
How long will I need to keep taking valproate for? Common
Valproate is a ‘preventative medicine’. It is therefore important that Increase in Eating more and A diet full of vegetables and
you keep taking valproate until your doctor tells you to stop. Do not appetite and putting on weight. fibre should prevent weight
stop taking it just because you feel better. If you stop them before weight gain gain. See also separate
you are advised to do so your fits or symptoms may get worse. (See question in this section.
also ‘What should I do if I forget to take a dose’).
Uncommon
Is valproate addictive? Gastric You have an upset Take your valproate with or
Valproate is not addictive. irritation stomach. This after food. If this is severe or
usually happens at does not go away, see your
Can I stop taking valproate suddenly? the start of doctor now.
This is a ‘preventative medicine’. Never stop taking this medication treatment.
suddenly or without advice from your doctor as this might mean an
increase in your fits or blackouts. When the time comes to stop your Hair loss Some of your hair Discuss with your doctor.
valproate, this will usually be by a slight reduction in your dose every falls out and may This can be upsetting for
few weeks. seem thinner. This some people. Sometimes it
stops after a while. grows back a little curly.

4 5
Side effect What happens What to do about it Side effect What happens What to do about it
Uncommon Rare
Nausea Feeling sick. If it is bad, contact your Thrombocyto- Low numbers of You may bruise without
doctor. penia and platelets in your reason and bleed easily. Stop
impaired blood. The platelets taking valproate and see
Rare platelet that are there may your doctor now.
Drowsiness Feeling sleepy or Don’t drive or use function not work very well.
sluggish. This machinery. Ask your doctor
Rash A rash or itching Stop taking your valproate
usually happens if you can take your
seen anywhere on and contact your doctor
early in treatment valproate at a different
the skin. now.
and should go time.
away. Table adapted by Norfolk & Waveney Mental Health Partnership NHS Trust from the UK Psychiatric
Pharmacy Group leaflets. (www.ukppg.org.uk)
Impaired Your liver is not You may feel sleepy, be sick,
liver function working very well. lose your appetite and your Do not be worried by this list of side effects. You may get none at all.
skin may look yellow. Stop There are other rare side effects. If you develop any unusual
taking valproate and see symptoms ask your doctor about them next time you meet.
your doctor now.
Will valproate make me drowsy?
Tremor Feeling shaky. This may be due to the dose
of valproate you are taking. You may feel sleepy to start with so you must take care if you are
Discuss with your doctor. allowed to drive or when operating any type of machinery. This effect
should wear off after you have been taking them for a while.
Ataxia Being very unsteady Your valproate dose may
on your feet. be too high. Contact your Will valproate cause me to put on weight?
doctor now. Valproate can cause some people to become more hungry and they
may then put on weight. A few people may put on weight even
Confusion Your mind is all Your valproate dose may be
without eating more. If you start to put on weight or have problems
mixed up. too high. Contact your
with your weight, your doctor can arrange for you to see a dietician
doctor now.
for advice.
Lethargy You feel tired all Your valproate dose may be
the time and don’t too high. Contact your
feel like doing doctor now.
anything.

6 7
Will valproate affect my sex life?
Drugs can affect desire (libido), arousal (erection) and orgasmic
ability. Valproate has not been reported to have a major adverse
effect on these three stages. However, if this does seem to happen,
you should discuss this with your doctor, as a change in dose may
help minimise any problem.
Can I drink alcohol while I am taking valproate?
There is not a complete ban on drinking alcohol if valproate is taken,
but make sure you do not take more than one or two drinks a day as
it may make you feel more sleepy. This is particularly important if you
are allowed to drive or operate machinery and you must seek advice
on this.
Are there any foods or drinks that I should avoid?
Fizzy drinks (e.g. colas) can produce stomach upsets if taken with the
uncoated ‘Epilim’ tablets (100mg) or syrup. This does not happen with
the other tablets or capsules. Other than this you should have no
problems with any food or drink other than alcohol (see above).
Will valproate affect my other medication?
If you are taking enteric coated tablets or capsules, do not take
indigestion remedies at the same time of day. This is because
indigestion remedies contain alkalis, substances which can break
down the coating of the tablet before it reaches the stomach. You
may then get more side effects. If you need to take something for
indigestion wait for at least two hours after taking your sodium
valproate EC tablets or capsules.
Antidepressants and antipsychotic drugs can decrease the effect of
this drug. Make sure your doctor knows if you are on either of these,
or any other medication as he or she will be able to adjust your
8 9
medication accordingly. If you have a headache it is best to take
paracetamol rather than aspirin while you are taking valproate. This
does not necessarily mean that some of these drugs cannot be used
together, just that you may need to follow your doctors instructions
very carefully.
If I am taking a contraceptive pill, will this be affected?
It is not thought that the contraceptive pill is affected by valproate.
What if I want to start a family or discover I’m pregnant?
It is important to consider that there will be a risk to you and your
child from taking a medicine during pregnancy but also a possible risk
from stopping the medicine e.g. getting ill again. Unfortunately, no
decision is risk-free. It will be for you to decide with your doctor
which is the least risk. It is important that you receive appropriate
information, so you can make an informed decision.
If possible, the best option is to plan in advance. If you think you
could become pregnant, discuss this with your doctor and it may be
possible to switch to medicines thought to carry least risk, and take
other risk-reducing steps e.g. adjusting doses, taking vitamin
supplements etc.
If you have just discovered you are pregnant, don’t panic, or stop
taking your medication suddenly, but seek advice from your GP or
psychiatrist as soon as possible. Very few medicines have been shown
to be completely safe in pregnancy and so no manufacturer or advisor
can ever say any medicine is safe. They will usually advise not to take
a medicine during pregnancy, unless the benefit is much greater than
the risk. You should always seek personal advice from your psychiatrist
or GP, who may then if necessary seek further specialist advice.
Will I need blood tests?
For the first six months of treatment you will need a regular blood
test (e.g. every month) to check that the drug is not affecting your
liver.
You may also then need to have blood tests from time to time to
make sure that the dose of valproate is enough and not too much or
too little for you.
Can I drive while I am taking valproate?
If you have epilepsy, it is essential that you report this, as well as
sudden disabling attacks of loss or partial loss of consciousness, to the
‘Driver and Vehicle Licensing Centre’ (DVLC). The DVLC will then
make a medical assessment of your condition consulting with your
doctor(s) where necessary. For more information see leaflet ‘D100’
(‘What you need to know about driving licensing’) which is available
from most post offices, or contact the Driver Enquiry Unit, DVLC,
SWANSEA SA6 7JL. (Telephone: 01792 772151 between 8.15 am to
4.30 pm from Monday to Friday). You will need to quote your Driver
Number whether you write or telephone. If you are taking valproate
to help stabilise your moods, it is not necessary to do this. Your doctor
will be able to advise you, and you may wish to access the UK Driver
and Vehicle Licensing Agency (DVLA) guidelines website, which has
the current DVLA guidelines on anxiety/depression, psychotic
disorders, mania and other conditions or for epilepsy. If your doctor
advises you not to drive, and you continue to do so, the doctor can
inform the DVLA directly, as he or she would be lawfully responsible
were you to have an accident. Once told, the DVLA may wish to carry
out an enquiry, but you are entitled to drive until a decision is made.
If you are allowed to drive remember that valproate can make you
drowsy when you first start taking it, so care should be taken when
driving or operating any type of machinery.
10
How can I find out more about my medication and
alternative treatments and therapies for mood
disorders?
You should discuss any questions or concerns you have about your
treatment with your Doctor, GP, pharmacist or mental health worker.
Your pharmacist will also provide you with a Product Information
Leaflet each time your medicine is dispensed to you.
Further information can be obtained from the National Institute for
Health and Clinical Excellence (NICE), which is part of the Department
of Health. NICE provides guidance and information about all NHS
services and treatments, and has produced information about mood
disorders.
You can download ‘Bi-polar Disorders - New Drugs (No66)’ from the
NICE internet website - www.nice.org.uk
The mental health charity MIND has produced a range of information
about therapies and medication, including information about mood
disorders. You can download a copy of their leaflet - ‘Understanding
Manic Depression’ from the MIND website at www.mind.org.uk/
information/factsheets
The Royal College of Psychiatrists has also produced an information
leaflet ‘Medications for mania’. This can be downloaded from the
Royal College website at www.rcpsych.ac.uk/info
Copies of these leaflets can also be obtained from the Patient
Information Centre at Tameside General Hospital. Although the
centre is based at Tameside Hospital, it provides information leaflets
to Pennine Care service users and carers in all areas. You can visit the
centre, telephone or email to request a copy of the NICE, MIND or
Royal College leaflets.
11