The valproate prescription pattern for female mental healthcare users of reproductive age

Abstract

Background: Sodium valproate (valproate) that is used both as an anti-epileptic and a mood stabiliser is teratogenic in pregnancy. A Dear Health Care Professional Letter (DHCPL) issued in December 2015 recommended the avoidance of sodium valproate prescription in women of childbearing age (WOCBA) and pregnant women.

Aim: This study aimed to describe the prescription pattern of valproate in female mental healthcare users (MHCUs).

Setting: Regional hospital psychiatry department in King Dinizulu Hospital Complex, Durban, KwaZulu-Natal.

Methods: This was a descriptive, retrospective chart review of female in- and out-patient aged 12–55 years who were receiving a valproate prescription for mental illness between 01 January 2018 and 31 December 2020.

Results: Of the 158 females who received valproate during the study period, 15 (9.5%) had it tapered off while 143 (90.5%) were continued. Only 19% of all the patients had documented counselling regarding valproate, 19 (12%) had documented contraceptive use, and six (3.8%) continued its use at any point during pregnancy. The most frequently prescribed dose range was 800 mg – 1499 mg/day (n = 111, 70.7%) and the most common psychiatric indication was a psychotic disorder.

Conclusion: This study showed that prescription of valproate in female MHCUs still occurs in practice in a referral centre in South Africa despite the guidelines outlining management of those of reproductive age on valproate. The prescription pattern and monitoring of valproate were poorly documented in relation to the guideline.

Contribution: This study highlights the lack of adherence to recommendations regarding the prescription of valproate in WOCBA and the need for improved documentation of the indications, consent and counselling.