Valproate alert puts GPs in a quandary
The Government has ordered GPs not to start any woman of childbearing age on sodium valproate without specialist advice.
Experts say the ruling by the Committee on Safety of Medicines will make it impossible for GPs in many areas to comply with guidance from NICE.
NICE is set to recommend older drugs such as valproate and carbamazepine as first-line therapy. But a dearth of neurologists means many GPs may be forced to initiate patients on more expensive newer drugs to heed the CSM warning, which applies to around 40 per cent of epilepsy sufferers.
The alert was issued after the CSM reviewed new data on congenital malformation rates from the UK pregnancy and epilepsy register and a foreign birth registry study. Product information will be updated as a result.
Dr Tim Betts, medical adviser to the British Epilepsy Society, said many GPs were forced to initiate medication. 'Often they have such long waits before a patient can be seen in secondary care that they unfortunately have to.'
Dr Betts, consultant neuro-psychiatrist at the University of Birmingham, called on NICE to differentiate between prescribing for women and men.
'In women, it's much better to start with lamotrigine or Keppra [levetiracetam]. I know they're more expensive but [the NHS cost of] a spina bifida baby is about £2 million.'
Professor David Chadwick, president of the British branch of the International League against Epilepsy, agreed many GPs faced problems with access to neurologists. But he branded GPs who prescribed valproate without specialist advice 'cowboys'.
Professor Chadwick, professor of neurology at the University of Liverpool, said some women would still have to take valproate as it was the most effective drug at seizure control in idiopathic generalised epilepsy. He urged GPs to be cautious when reviewing women on the drug and repeat prescribing.
The rate of malformations in children born to mothers on anti-epileptic medication is two- to threefold higher than in the general population.