Introduction
The study assesses the use of sodium valproate and other antiepileptic drugs in England and Wales between 2019 and 2023, with a particular focus on women of childbearing age. Sodium valproate is widely used for epilepsy and bipolar disorder, but is teratogenic, with significant risks during pregnancy.
Methods
Data were extracted from linked electronic health records such as NHS England and SAIL in Wales. Trends in sodium valproate use, incident pregnancies and epilepsy-related mortality were analysed.
Key Findings
1. Reduction in Use in Women of Childbearing Age:
• Between 2019 and 2023, prevalent use of sodium valproate in women aged 15–49 years fell from 7 to 5 cases per 100,000 women.
• The number of pregnant women using sodium valproate fell from 140 in 2019 to 85 in 2023.
2. Substitution with Alternatives:
• Alternative medicines such as lamotrigine and levetiracetam saw an increase in use in women in this age group.
3. Geographical Disparities:
• Regional differences in valproate use were identified, with areas such as the North West of England having higher rates.
4. Impact on Pregnancy:
• Most women who used valproate during pregnancy received doses of less than 1 g/day.
• Although there was evidence of guidance on the risks of the medicine, records of counselling in the pregnancy prevention programme were inconsistent.
5. Mortality Rates:
• There was no significant increase in epilepsy-related deaths in women, but a slight increase was observed in men after 2018.
Discussion
The data indicate a positive regulatory response to reducing sodium valproate use in women of childbearing potential, especially during pregnancy. However, implementation of pregnancy prevention programs has been uneven, highlighting the need for increased surveillance and more detailed reporting.
Conclusion
The use of sodium valproate in women of childbearing potential continues to decline, reflecting regulatory efforts and increased awareness of associated risks. However, the analysis suggests that more integrated approaches and improved registries are needed to maximize patient safety and track the impacts of this medicine’s use in different populations.
Reference
Dale, C.E., Takhar, R., Fan, Y.Y., & Torabi, F. (2024). Use of sodium valproate and other antiseizure drug treatments in England and Wales: quantitative analysis of nationwide linked electronic health records. BMJ Medicine, 3(1), e000760. Available at: https://bmjmedicine.bmj.com/content/3/1/e000760
