Valproate

You will need to take valproate for several months after you feel better, otherwise your symptoms can come back.

Your doctor will advise you how long you'll need to stay on valproate, as it depends on what you are taking it for. If you are taking it to prevent the symptoms of mania from coming back, it might be about six months.

If you stop taking the valproate too soon, there is more chance that your symptoms will come back.

You will get the most benefit from your valproate if you take it every day.

Make sure that you know your dose. If it is not written on the label, check with your pharmacist or doctor.

Valproate semisodium is normally taken twice a day but sometimes it may be three times a day.

The starting dose is normally 750mg per day but will probably be increased to between 1000mg and 2000mg a day.

Sodium valproate is available as ‘controlled-release’ (also called ‘prolonged-release’) tablets, capsules and granules that mean you only need to take it once a day.

The controlled-release capsules or tablets should be swallowed whole with a glass of water and not crushed or chewed.

The controlled-release granules can either be sprinkled on a small amount of soft cold food, taken in a drink, or poured directly into the mouth and washed down with a cold drink. If the granules are added to a drink, after you’ve had the drink the glass should be rinsed with a small amount of water and you should drink this water as well, as some granules may stick to the glass. The granules should not be crushed or chewed.

Controlled-release medicines might help you if you find it difficult to remember all the doses and would otherwise need to take doses at school, university or work.

Valproate can be taken with or after a meal. Taking it with food can help to reduce the chance of feeling sick. Not everyone feels sick with valproate, but this is one of the possible side effects.

Some of the valproate preparations have a special coating (“enteric” or “gastro-resistant” coating) to protect the tablet from stomach acid. This tablet should be swallowed whole with a glass of water - do not chew it as it tastes bitter and you will break the protective coat.

If you remember later during the day, take it as soon as you remember - unless you are less than four hours away from your next dose. If you forget to take it by then, just start again with the next dose.

Do not take a double dose.

If you forget to take it for a few days, you may start getting your symptoms back and should talk to your doctor about it.

Once you start taking valproate, the brain adjusts to having its calming effect. If you stop taking the valproate all at once, the chemical balance in your brain starts to change again, meaning you could get your old symptoms back.

However, you can stop taking valproate safely with your doctor’s help.

Go and speak to your doctor if you have missed a few doses or have decided to stop taking your medication.

When you agree with your doctor to stop the medicine, you will carry on with a dose that gradually decreases over about a month.

If you have taken more valproate than the dosage recommended by the doctor who prescribed it to you, you must get medical help immediately – even if you do not feel any different.

Valproate can make some people think about hurting themselves or taking their own lives. You must go straight to hospital with your tablets if you have any of these thoughts.

Valproate can sometimes cause other rare but serious side effects: allergic reactions (difficulty breathing, swelling of your face or throat, itching skin lumps), problems with your liver or pancreas (suddenly feeling weak, not wanting to eat, feeling sleepy or confused, severe stomach pain, feeling or being sick, or the whites of your eyes changing to yellow) and problems with your blood cells (which might show as bruising, getting more infections than usual, a sore throat, feeling weak, tired, dizzy or having very pale skin). Go to a hospital with your medicine if you get any of these symptoms.

Stopping valproate suddenly can cause symptoms to return. If you are thinking of stopping or want to stop, talk to your doctor first.

You might feel sleepy in the first few days after taking valproate. Do not drive a car, ride a bike or operate machines until you see how this affects you.

If you are pregnant, or thinking of becoming pregnant, please read the question about pregnancy in the FAQ section above. Valproate is very likely to affect the developing baby. Valproate can cause serious harm to a developing baby and should no longer be prescribed to women and girls who are able to have babies unless they are on the valproate pregnancy prevention programme (Prevent).

If you have taken more valproate than the dosage recommended by the doctor who prescribed it to you, you must get medical help immediately – even if you do not feel any different. Go to A&E. Take your medicine with you to show to the doctors. Tell them how much you have taken. Get a friend to go with you, if you can, just in case you feel ill on the way.

You might get any of the following signs:

• being sick
• headache
• blurred eyesight
• confusion and tiredness
• weak or ‘floppy’ muscles, with no reflexes
• seizures (fits)
• loss of consciousness (blackouts)
• behavioural changes
• breathing difficulties such as fast breathing, shortness of breath or chest pain

While taking valproate, some people may think about hurting themselves or taking their own lives. This can happen to anyone, including people who are under 18. You must go straight to hospital with your tablets if you have any of these thoughts. You must tell the doctor that you are taking valproate.

Stop taking valproate and go to a doctor or hospital straight away if you get any of the following allergy symptoms:

• rash
• joint pain
• fever
• swallowing or breathing problems
• swelling of your lips, face, throat or tongue
• swelling of your hands, feet or genitals

Stop taking valproate and go to a doctor or hospital straight away if you get any of the following symptoms (which may be signs of a problem with your liver or pancreas):

• feeling weak, general feeling of being unwell
• loss of or decreased appetite
• feeling drowsy, confused or tired
• oedema (swelling of your feet and legs)
• nausea (feeling sick) or vomiting (being sick)
• stomach pain, which may feel very bad and reach through to your back
• jaundice (eyes or skin going yellow)

Stop taking valproate and go to a doctor or hospital straight away if you get any of the following symptoms (which may be signs of a problem with your blood cells):

• feeling weak, tired, faint, dizzy or having unusually pale skin.
• bruising more easily, or unusual bruising or bleeding
• getting more infections than usual with fever, severe chills, sore throat or mouth ulcers

Very common side effects (affecting more than one in ten) include:

• nausea (feeling sick)
• tremor (shakes)

Common side effects (affecting up to one in ten) include:

• changes in blood markers
• short-term hair loss – expect re-growth within six months but likely to be more curly
• painful periods
• weight gain

Keep taking your tablets, but tell your doctor as soon as possible if you get any of the following side effects:

• unusual behaviour, including being very alert, and sometimes also aggressive and/or hyper-active
• swollen arms or legs (water retention)
• bleeding a lot if you cut yourself
• loss of consciousness (blackouts)
• hallucinations (seeing or hearing things that are not there)
• memory problems, difficulty performing mental tasks, being unable to concentrate
• difficulty in speaking, or slurred speech
• muscle weakness, lack of co-ordination, muscle twitching or sudden jerks and shaking
• seizures (fits) for patients with epilepsy