There are several options for printing:

• Click "Print this page" on the left to print the whole section
• Download a handy PILL (Patient Information Leaflet), a two-page summary of the main questions and answers from here. This can then be printed.
• Download a handy QuILL (Quick Information Leaflet), a shorter, pictorial version of the PILL, designed for younger people. This can then be printed.
• Download a handy BILL (Brief Information Leaflet), a shorter, one page, larger print version of the PILL. This can then be printed.

There are many other Patient Information Leaflets (PILs) across the world for patients and carers. They are not on our site, so we can't take any responsibility for them but you can click here for links to other sites and leaflets. There are also official information leaflets (often called a Data Sheet, Package Insert, or Summary of Product Characteristics). Just be aware that some leaflets are for valproic acid, some for sodium valproate and some for valproate semisodium so be careful you get the right one for you.

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Not all the different forms of valproate are officially licensed for the same symptoms or conditions. However, when it comes to it, they could all be used for all the conditions.  

Valproate is approved to help treat the symptoms of:

• Bipolar mania or hypomania
• Epilepsy

Valproate can also sometimes be used to help some of the symptoms of:

• Bipolar mood disorder
• Bipolar depression
• Borderline Personality Disorder
• Depression
• Psychiatric emergency
• Migraines

There are other treatments for the conditions above. The main ones are included in the section on each of the conditions above.

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The usual dose of sodium valproate depends on what it is being taken for, your age, weight and which preparation you are having.

Epilepsy:

The usual starting dose is 600mg a day (sometimes split into two doses). This can then be increased to 1000-2000mg a day (1-2g). Sometimes it is worked out as 20-30mg per kg of the person's body weight each day (e.g. for a 70kg person the dose can be up to [70x20] to [70x30] i.e. 1400mg-2100mg a day).

In children under 12, the usual starting dose is 200mg twice a day. This can then be increased.

To stop migraines the usual dose for adults is about 200mg twice a day to start with, perhaps going up to 1200-1500mg (1.2-1.5g) a day. 

The usual dose in the elderly is usually a little lower than in adults as above.

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This will rather depend on what you are taking it for. To help you choose, click on the links for the main options (self-help and help from others), the main medicines, and a handy chart comparing the main medicines:

• Psychiatric emergency - main options, main medicines
• Bipolar mood disorder - main options, main medicines and handy chart
• Bipolar depression - main options, main medicines and handy chart
• Bipolar mania - main options, main medicines and handy chart
• Depression - main options, main medicines and handy chart
• Epilepsy - main options and main medicines

There are other treatments for the conditions above. The main ones are included in the section on each of the conditions above.

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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, if you're interested). Valproate may increase this "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.

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Take the valproate as directed on the medicine label. It is best to take valproate after food. If it is prescribed twice a day, this should best be morning and early evening. If you are taking it for epilepsy, it is particularly important to take this regularly as directed by your doctor to make sure that you are getting the best control from your medication. Missing a dose can cause your fits to return or your mood to get high or low.

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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.

Episenta® capsules can be emptied onto cold food or drink and swallowed straight away without chewing, as can the granules.

If it is necessary for you to have an injection it will be given by a nurse or doctor.

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This may depend on what you are taking it for. Click the link below for the answer for that condition:

• Bipolar mood disorder
• Bipolar depression
• Bipolar mania or hypomania
• Depression
• Epilepsy
• Psychiatric emergency 

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This will depend on what you are taking it for. It may also depend on how unwell you have been or how severe the symptoms have been, as people respond differently. Click on the link below for the answer for that condition:

• Bipolar mood disorder
• Bipolar depression
• Bipolar mania or hypomania
• Depression
• Epilepsy 

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Valproate is not addictive. If, however you have been taking it for epilepsy you should not stop it suddenly. If you do your fits may occur again. It is probably also not a good idea to stop any mood stabliser suddenly in case it destabilises you.

For a drug to be addictive or produce dependence, then it must have a number of characteristics:

• should produce craving for the drug when the last dose "wears off"

• there should be a "reward" (e.g. a good feeling) from taking the drug

• should produce tolerance ie you need more drug to get the same effect

• should produce withdrawal symptoms specific to that drug.

These characteristics come from the World Health Organisation. Valproate has none of these and so is not addictive.

Click here to read a bit more about this, where you can find our thoughts on this knotty problem.

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Start again as soon as you remember unless it is almost time for your next dose, then go on as before. Do not try to catch up by taking two or more doses at once as you may get more side-effects. You should tell your doctor about this next time you meet.

If you are taking valproate to help control fits or blackouts and you are ill and vomit soon (e.g. about an hour) after taking your tablets, you should take that dose again. Missing a dose can cause your fits to return. The amount in your blood may drop below the level needed to control your fits. Missing the occasional dose (e.g. once a week) isn't usually a big problem (unless you are taking it for seizures).

If you have problems remembering your doses (as very many people do) ask you pharmacist, doctor or nurse about this. There are some special packs, boxes and devices that can be used to help you remember. You can try leaving the pack somewhere you will see it each morning e.g. in the bathroom, kitchen, by your bed etc.

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There do not seem to be any withdrawal or discontinuation symptoms from valproate. However, as valproate helps stop bipolar mania or epilepsy coming back, stopping it suddenly or without advice from your doctor may well mean bipolar symptoms coming back or an increase in your fits or blackouts. When the time comes to stop your valproate, this should usually be by a slight reduction in your dose every few weeks.

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The table below will show you some of the main side effects you might get from valproate.

Do not be worried by this list of side effects. Some people get no side effects at all and others may get some effects that are not listed in this table. Side effects tend to be worse with higher doses. Starting with a lower dose sometimes helps. If you think you might have a side effect to your medicine, you should discuss this with your doctor, nurse of pharmacist. You should also see the manufacturer's information leaflet.

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You may feel sleepy to start with so you must take care if you are allowed to drive or when operating any type of machinery (see later question). This effect should wear off after you have been taking it for a while. If you get very drowsy, you should contact your doctor immediately, who may want to do a blood test to check on your liver.

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Valproate can cause some people to become more hungry and they may then put on weight. A few people may put on weight even without eating more. This seems to be more common in people with normal or lower weight. If you start to put on weight or have problems with your weight, your doctor can arrange for you to see a dietician for advice. You are less likely to gain weight with medicines like valproate if you have some include physical activity as well as dieting (Gaspari and Guerreiro 2010).

Weight gain can be part of the so-called ”metabolic syndrome”. You might want to read a bit more about this as maycbe up to 1 in 2 people on valproate may get metabolic syndrome (although the valproate may not always be the cause (Mania 2011).

Click here for a few tips on how to help you feel less hungry and lose weight.

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Drugs can affect desire (libido), arousal (erection) and orgasmic ability. Valproate has not been reported to have a major effect on any of these three stages. However, if this does seem to happen, you should discuss this with your doctor, as a change in dose or timing may help minimise any problem.

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Please see the separate medicines.

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There should be no problems with valproate.

If you are taking uncoated or soluble Epilim tablets (100mg) or the syrup and then then drink fizzy drinks (e.g. Colas) this can cause stomach upsets. This does not happen with the other tablets or capsules. Other than this you should have no problems with any foods or drinks, other than alcohol. As far as we know there is no problem with drinking grapefruit juice with valproate.

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Whether or not it is safe to drink alcohol with any medicine will depend on:

• How much you have to drink e.g. the amount and over how long
• What you then try to do (e.g. sleep or drive)
• If you have any other conditions e.g. epilepsy, asthma or a chest infection (as alcohol can make it harder to breathe)
• If you are taking any other medicines

Alcohol reaches all parts of the brain and can affect many things e.g. thinking, reactions and breathing. Alcohol can also boost the effect of GABA (the brain's main calming chemical messenger).

There is not a complete ban on drinking alcohol if you are taking valproate, but make sure you do not take more than one or two drinks a day as it may make you feel more sleepy. if this happens, you must take extra care if you need to drive or operate machinery. You must seek advice on this.  

It is not safe to drive after drinking alcohol, with or without valproate. Some countries allow driving after a small amount of alcohol but others have a zero tolerance. The UK has the highest limit in Europe, France lower, Scandanavia even lower and zero in some Eastern European countries. It is not possible to say what blood level you might have from a drink so it is safest not to drink if you know you may have to drive. It is taken as a very serious offence in most countries. You should see National Guidelines, laws and regulations in the country in which you are driving.

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Valproate has a few interactions with other medicines:

• Valproate should only be used with care with phenytoin
• 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 2 hours after taking your sodium valproate EC tablets or capsules
• The effects of valproate can sometimes be increased by erythromycin or fluoxetine
• The effect of valproate can be decreased by antiretrovirals, some antibiotics (e.g. doripenem, ertapenem, imipenem and meropenem; these can cause a sudden drop in valproate in the blood), carbamazepine, topiramate or oxcarbazepine
• Valproate can sometimes decrease the effect of olanzapine
• Valproate can increase the effect of tricyclics (e.g. dosulepin/dothiepin, imipramine, lofepramine), some antiretrovirals (e.g. zidovudine), carbamazepine, lamotrigine, phenobarbital, rufinamide, tiagabine or phenytoin.

This does not necessarily mean that this will happen in everyone or that some of these medicines can not be used together. It is just that you may need to follow your doctor's instructions very carefully. There are other possible drug interactions (e.g. you can try an external on-line drug interactions checker, although this is nothing to do with our site).

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Cigarette smoke contains over 3000 different chemicals. Some of these chemicals can make some of the enzymes in the liver work faster (called "enzyme induction" of e.g. CYP1A2 or P4501A2). This means that any medicine those enzymes break down will be broken down quicker. So, you'll end up with less of that medicine if you smoke. And also you will have more of it in the body if you stop smoking. However, valproate does not seem to be affected so there seem to be no extra problems if smoking with valproate.

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By including this section, we're not saying it's right to take illicit or illegal drugs, because it isn't. We're just trying to answer the questions as best we can under the circumstances. With illicit drugs, the full answer is usually that we don't really know. So, we can only go on a few studies, a few reports and what we know about the drugs themselves.

Cannabis (illegal in most countries):

Smoking cannabis increases the amount of dopamine in the pleasure centres of the brain, which is where the reward or buzz comes from. However, psychosis also comes from having too much dopamine in another area of the brain. You have to remember that cannabis can increase dopamine in all areas of the brain and so can make psychosis worse. Please be careful, everything in moderation and if dope makes you worse, keep off the grass. It really won't help you in the long-term. Don't forget that if you're a toker, you're also a smoker, so see the question above. However, valproate does not seem to be affected so there seem to be no extra problems if smoking cannabis with valproate.

Cocaine (illegal in most countries)

Cocaine is of course highly addictive and has many adverse or side effects on the body and brain. It can make most mental health symptoms worse in the long-term. However, there are no reports of extra problems with valproate and cocaine, although this doesn't mean it's safe.

Ecstasy (illegal in most countries)

Ecstasy has many effects on the brain, the main ones producing the high seem to be by boosting serotonin, noradrenaline and dopamine in the brain. While it can cause a high, the effect wears off fairly quickly. It seems that the toxic effects on the brain are cumulative i.e. the more tablets you have over your lifetime, the more chance you have of having damage to the brain e.g. long-term depression and poor memory. However, there are no reports of extra problems with ecstasy and valproate, but again this doesn't mean it's safe.

Opiates

The opiates include many chemicals, some of which are used in medical care (e.g. codeine for diarrhoea and stopping coughs, diamorphine and morphine for pain). However, there are no extra problems reported from taking opiates (e.g. heroin, methadone, codeine) with valproate, although you might feel more drowsy.

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You should have no problems with "The Pill" and valproate.

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In the UK, Levonelle one step® is available and is usually known as 'the morning after pill'. It is taken to reduce the chances of becoming pregnant after unprotected sex or failure of a contraceptive method. In fact "Emergency Contraception" is the better term because it can be taken up to 72 hours (3 days) afterwards. It can be bought over-the-counter without a prescription from pharmacies. EllaOne® tablets (which may work up to 5 days afterwards) and a coil (Intra-uterine device) can also be used but must be prescribed by a Doctor.

If you are taking valproate, the usual dose should work if you follow the instructions carefully.

N.B. We accept that for religious, cultural or ethical reasons some people do not approve of, or agree with, the use of the "Morning After" pill. However, we have answered the question because it is one of the most often asked of NHS Direct in UK, and they suggested we include it.

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Several female functions such as menstrual cycle (e.g. your periods) are controlled by a hormone called prolactin. Prolactin in the body rises during and after pregnancy and this triggers the body to make breast milk. The amount of prolactin in the body is kept in control by one part of the brain uses dopamine as its chemical messenger. Some medicines (especially antipsychotics) block the effect of dopamine in the brain.

Luckily valproate doesn't seem to have any effect on dopamine in this part of the brain and so should not have any effect on your periods. If your periods are irregular or late, or you start leaking milk, then you should see your doctor about this to find the cause.

^{Updated 11.11}

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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 which is the least risk. All we can do here is to help you understand some of the issues, so you can make an informed decision. For your information, major malformations occur "spontaneously" in about 2-4% of all pregnancies, even if no drugs are taken. The main problem with medicines is termed "teratogenicity" i.e. a medicine causing a malformation in the unborn child. A medicine causing teratogenicity is called a "teratogen". Since a baby has completed it's main development between days 17 and 60 of the pregnancy (the so-called "first trimester") these first 2-16 weeks are the main concern. After that, there may be other problems e.g. some medicines may cause slower growth. The infant may also be affected after birth e.g. withdrawal effects are possible with some drugs.

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, but seek advice from your GP within the next few days if possible. He or she may also want to refer you on to someone with more specialist knowledge of your medicine.

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. In the UK, there is the NTIS (National Teratology Information Service) who offer individual risk assessments. However, their advice should always be used to help you and your doctor decide what is the risk to you and your baby. There is a risk from taking the medicine and a risk should you stop a medicine e.g. you might become ill again and need to go back on the medication again. The advice offered here is just that i.e. advice, but may give you some idea about the possible risks and what (at the time of writing) is known through the medical press.

It may be helpful to know that in the USA, the FDA (Federal Drug Administration) classifies medicines in pregnancy in five groups:
A = Studies show no risk, so harm to the unborn child appears only a remote possibility
B = Animal and human studies indicate a lack of risk but are not fully conclusive
C = Animal studies indicate a risk but there is no safety data in humans
D = a definite risk exists but the benefit may outweigh the risk in some people
X = the risk outweighs any possible benefit

Valproate is classified as "D". There is quite a lot of evidence of problems e.g. a 1 or 2 in 100 chance of spine problems e.g. spina bifida, autism or a "valproate syndrome". You will need to seek personal advice from an expert, as counselling and screening at a specialist centre is recommended. Taking folic acid supplements throughout pregnancy (and possibly before) may reduce this risk. You will of course also need to consider the risk of relapse if you stop your valproate. It is strongly recommended not to take valproate in pregnancy unless it is essential.

Several studies suggest that there may also be a higher chance of a child having higher educational needs if the mother took valproate throughout pregnancy, and may have a lower IQ (e.g. Cummings 2011). If you are taking valproate for epilepsy, then you will need to also consider the risk of seizures as well, if the medication is stopped.

If you have to take valproate while you are pregnant (for what ever reason) you can hep the chances of a successful pregnancy as follows:

• Have the lowest possible dose that works
• Take your doses 2-4 times a day (this means that you don't get such high "peak" blood levels)
• Have just valproate, as the risk seems to be higher if other medicines are taken as well  
• Take folic acid before and during pregnancy ^{(Ornoy, 2009)}

  ^{Reviewed 3.13}

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Almost every medicine passes into breast-milk. The main questions are how much and if this is likely to have an effect on your baby. But also remember that being ill (e.g. depressed, manic, psychotic) may have more harmful and lasting effects on you and your child (such as bonding and behaviour e.g. Field, 2010) than a small amount of an effective medicine. If you have been taking a medicine while you are pregnant, you should usually be able to carry on as the amount in breast-milk is much less than the baby would have got while you were pregnant. It is usually thought to be fairly safe if the baby gets less than 10% of the mum's dose. But there may be times when although a medicine gets into breast milk the benefit may be worth the risk, so you should seek personal advice on this.

If you want to breast-feed there are some things you can do to reduce any risk:

• Nearly all medicines can be taken once a day. So, taking your daily dose just before the baby's longest sleep (often this will be at night) will reduce the amount the baby gets from the milk.
• Any side effects in the baby will be higher if the mum is taking a higher dose. So, try to take the lowest dose possible to still get an effect.
• Try not to take any medicines you don't really need. This includes any medicines you might buy over-the-counter
• Make sure your nurse, health visitor or doctor checks your baby for any side effects e.g. being extra sleepy, having colic, feeding problems, being floppy or poor weight gain. If there are any problems you might need to switch medicines or drop your dose a bit
• Hind milk (the second half of the feed) is likely to contain slightly more of any medicine than the first half
• Avoid new medicines if possible as there is less information about them and breast-feeding.

You must be extra careful of any medicines if your baby was pre-mature, or has kidney, liver, heart or brain problems.

We know that some valproate gets into breast milk and this can vary from mum to mum. However, based on two studies, it is almost always at a low level and so would be a low risk if you are taking a low dose. If you want to breast feed when taking valproate, or are on a high dose (e.g. somewhere around 1000mg a day or more), you should get some personal expert advice on this. One large study showed that breast feeding while someone is taking valproate has no harmful effects on the child's development over the next 3 years.

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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.

If you are taking any medicines (especially if for epilepsy or bipolar disorder), the rules about driving will depend on the country you’re driving in. Click on the links below for advice:

• Medicines and driving in the UK (England, Scotland, Northern Ireland and Wales)

• Medicines and driving in the Republic of Ireland

General advice on driving safely

If you want to drive, you should take sensible steps to reduce any risk. These could include:

• Avoid driving when you are tired or ill
• Do not drive after having any alcohol as this can make any drowsiness worse (a third of all fatal road traffic incidents involve alcohol-dependent drivers)
• Avoid driving at night, dusk or in bad weather
• Avoid motorways, dual carriageways and the rush hour
• Give yourself plenty of time. Don’t rush
• Be extra careful if you have not slept well the previous night

As some medicines can affect your driving, be extra careful:

• If starting a new medicine
• After a change in dose (especially an increase)
• If you are on a high dose or seem very sensitive to side effects
• If you are taking any medicines for other symptoms e.g. antihistamines for hay fever or allergies
• If your medicine causes you blurred vision, drowsiness, poor co-ordination, poor attention

If you are driving less than 2000 miles a year, once you consider insurance, tax, MoT, repairs, maintenance, parking and petrol, you may actually find it is cheaper to get taxis and busses, and walk the short journeys.

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For the first 6 months of treatment you ought to have a few blood tests (e.g. every month) to check that valproate is not affecting your liver. If you are taking valproate for epilepsy, 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.

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A. Medicines and Healthcare products Regulatory Agency (MHRA)

In 2012 the UK Medicines and Healthcare products Regulatory Agency set up a Medicines Safety Information part of their website. You will have to search for the medicine or medicines you want to look for. The parts you might find of interest are as follows:

Drug Analysis Prints (DAPs)

DAPs contain a complete list of all possible side effects that have been reported by healthcare professionals and patients to the MHRA, via the Yellow Card Scheme. Each DAP lists all of the reactions reported by health professionals and patients for a particular medicine.

• C&M note: Please be careful reading this section. It includes all possible side effects listed against every medicine someone was taking. So, if all your hair fell out while you were taking 5 medicines, this event would be listed against all five medicines, even though only one or even none might have been the cause. The idea is to try to get all information and perhaps find some rare side effects. The numbers of reported cases also depend on how often the medicine is prescribed e.g. 50 reports based on 500 prescriptions is worth looking at, but 5 cases based on 5,000,000 prescriptions could well just be chance.

Public Assessment Reports (PARs)

The MHRA's assessment of a medicine can be found in the Public Assessment Reports (PARs), although commercial and personal confidential information has been taken out. PARs are usually available for medicines licensed in the UK after 30 October 2005.

Summaries of Risk Management Plans

A Risk Management Plan (RMP) is a document that describes all the available knowledge about the safety and effectiveness of a medicine.

Drug Safety Update (DSU)

Drug Safety Update is the MHRAs monthly newsletter for healthcare professionals. It has information and clinical advice on the safe use of medicines.

Summaries of Product Characteristics (SPCs) and patient information leaflets (PILs)

This page contains the official product information. Every medicine pack includes a patient information leaflet (PIL), which provides information on using the medicine safely. PILs are based on the Summaries of Product Characteristics - a description of a medicinal product's properties and the conditions for its use. These are also linked from the leaflets question above.

B. European Medicines Agency (EMA)

The European Medicines Agency (EMA) is the body that approves medicines for use in the EU. The EPAR is all the scientific stuff put in a readable way. It explains how and why the Committee for Medicinal Products for Human Use (CHMP) looked at the information on each drug and decided to allow it to be marketed ("granting a marketing authorisation" as the call it). 

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