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 Formulary Chapter 4: Central nervous system - Full Chapter
04.02.03  Expand sub section  Drugs used for mania and hypomania
 note 

Aripiprazole, olanzapine, quetiapine and risperidone are licensed for acute mania. Aripiprazole, olanzapine and quetiapine are licensed for the prevention of recurrence of mania. Quetiapine is also licensed for bipolar depression and the modified release formulation as an add-on treatment of major depressive episodes in patients with Major Depressive Disorder (MDD) who have had sub-optimal response to antidepressant monotherapy. 

04.02.03  Expand sub section  Benzodiazepines
04.02.03  Expand sub section  Carbamazepine
04.02.03  Expand sub section  Valproic acid
 note 

Valproate should not be prescribed routinely for women of child-bearing potential.  If there is no alternative ensure the woman is using a robust method of contraception. 

The equivalent amount of valproic acid in a Depakote 500mg and a sodium valproate 500mg tablet are 500mg and 433mg respectively.

Sodium valproate
(Mania) (EC tablet, MR tablet, crushable tablet, oral solution)
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Restricted Drug Restricted
Amber No SCG

  • Requires specialist initiation by mental health team

  • For this indication the preferred brand for sodium valproate MR is Episenta®

  • MHRA/CHM advice: Valproate is contraindicated in women and girls of childbearing potential unless conditions of the Pregnancy Prevention Programme are met 



 

 
Link  March 2019: Stock availability of Valproate-containing products (Sanofi)
Link  MHRA Drug Safety Update September 2018: Valproate Pregnancy Prevention Programme - actions required now from GPs, specialists, and dispensers
Link  CPFT Medicines Monitoring Guidelines
Link  MHRA Drug Safety Update April 2019: Valproate medicines and serious harms in pregnancy - new Annual Risk Acknowledgement Form and clinical guidance from professional bodies to support compliance with the Pregnancy Prevention Programme
Link  MHRA Drug Safety Update February 2020: Valproate (Epilim▼, Depakote▼) pregnancy prevention programme - updated educational materials
Link  MHRA Drug Safety Update May 2018: Valproate medicines (Epilim▼, Depakote▼) - Pregnancy Prevention Programme
Link  Valproate Risk Materials
   
Valproic Acid (Depakote)
(EC tablet)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Amber No SCG

 

  • Requires specialist initiation by mental health team.
  • MHRA/CHM advice: Valproate is contraindicated in women and girls of childbearing potential unless conditions of the Pregnancy Prevention Programme are met. 
  • Licensed for the treatment of manic episodes associated with bipolar disorder.
  • Prescribe as “Depakote” to avoid confusion with sodium valproate.

March 2020 - Supply issue with Depakote (valproate semisodium) 250mg and 500mg g/r tablets

  • Depakote 500mg tablets are out of stock until early April 2020.
  • Depakote 250mg tablets will be out of stock from early March until early April 2020. 
  • For actions to deal with this shortage see Medicine Supply Notification link below. 
  • There is also a shortage of Convulex (valproic acid) which is the only licensed valproic acid treatment of generalised, partial or other eplepsy in children and adults. Patients who are prescribed Depakote for off-license use in epilepsy indications, advice should be sought from their epilepsy specialist responsible for their care. 

 

 
Link  March 2019: Stock availability of Valproate-containing products (Sanofi)
Link  MHRA Drug Safety Update September 2018: Valproate Pregnancy Prevention Programme - actions required now from GPs, specialists, and dispensers
Link  CPFT Medicines Monitoring Guidelines
Link  March 2020: Medicine Supply Notification - Depakote 250mg and 500mg tablets
Link  MHRA Drug Safety Update April 2019: Valproate medicines and serious harms in pregnancy - new Annual Risk Acknowledgement Form and clinical guidance from professional bodies to support compliance with the Pregnancy Prevention Programme
Link  MHRA Drug Safety Update February 2020: Valproate (Epilim▼, Depakote▼) pregnancy prevention programme - updated educational materials
Link  MHRA Drug Safety Update May 2018: Valproate medicines (Epilim▼, Depakote▼) - Pregnancy Prevention Programme
Link  Valproate Risk Materials
   
04.02.03  Expand sub section  Lithium to top
 ....
 Non Formulary Items
Valproic Acid  (Convulex)
(Capsules)

View adult BNF View SPC online View childrens BNF Track Changes
Non Formulary
Grey

 

  • Convulex (valproic acid) is only licensed for the treatment of generalised, partial or other epilepsy in children and adults. 
  • Convulex is NOT licensed for mental health conditions.
  • Please see information above regarding the pregnancy prevention programme that applies.  

March 2020 - Shortage of Convulex (Valproic acid) 150mg, 300mg and 500mg capsules


 

 

 

 
  
Key
note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Unlicensed
Track Changes
Display tracking information
click to search medicines.org.uk
Link to adult BNF
click to search medicines.org.uk
Link to children's BNF
click to search medicines.org.uk
Link to SPCs
SMC
Scottish Medicines Consortium
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHSE
NHS England
Homecare
Homecare
CCG
CCG

Traffic Light Status Information

Status Description

OTC

Available Over the Counter. Consider Self Care   

Green

Formulary - Can be prescribed in both secondary and primary care.   

Advice

Formulary - Specialist Advice, secondary care advice provided for primary care initiation.  

Amber No SCG

Formulary - Specialist initiation without shared care guidance.  

Amber SCG

Formulary - Specialist initiation with shared care guidance.  

Red Hospital

Restricted - Hospital only, not to be prescribed in primary care.  

Switch

Not recommended for prescribing. Switch to alternative cost-effective option.   

Black

Not recommended for prescribing in primary or secondary care.  

Grey

Not recommended as no formal application made for addition to the formulary. Contact relevant pharmacy team for further information.   

Non Formulary

Non-Formulary (category under review).  

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