Valproate

It usually only takes a few days for valproate to start working. It may take several weeks or months for you to feel the maximum effects on stabilising your mood.

If you are having a manic episode, the doctor is likely to increase your dose quite quickly over a few days.

Your dose is likely to be reduced in the longer term to get the best effect for you. This is because you are unlikely to need the same high dose as you would in a manic episode to provide longer-term benefit.

Your weight can be affected by valproate.

Valproate can make some people feel hungrier than usual. If you are eating more than usual, you can put on weight.

It is not possible to predict how valproate will affect each person before they start taking it. Talk to your doctor or pharmacist if you are concerned about your weight, or changes to your weight, while taking valproate.

Making sure you do enough exercise and eat a healthy diet (with vegetables and fibre) can help you to avoid putting on too much weight. Exercise is also good at helping with your mood.

Mental health conditions like bipolar disorder can make being active and eating healthily more of a challenge. Talk to your doctor, pharmacist and specialist healthcare team for lifestyle advice and where to get support if this would be helpful.

A common side effect of valproate is gingival disorder. This is a mild form of gum disease, also called periodontal disease. It causes irritation, redness, swelling and bleeding of your gum around the base of your teeth. You might have symptoms of swollen or puffy gums, gums that are tender and bleed easily when you brush or floss or bad breath. Make sure you brush your teeth well and have regular dental check-ups. Speak to your dentist, doctor or pharmacist about things you can do to help.

You may want to let your family and friends know you are taking valproate so they can support you and help you look out for side effects.

Alcohol

It is recommended that you don’t drink alcohol while taking valproate because the two together might make you feel very sleepy and unsteady on your feet, especially when you first start taking the medication.

However, you may be able to drink a small amount of alcohol in moderation.

During the first few weeks of treatment, it is recommended that you don’t drink alcohol until you know how the medicine affects you.

If you want to drink alcohol, it’s best to only drink small amounts, and have a plan for getting home safely if you go out.

Drinking alcohol regularly, or in large amounts, can make your symptoms worse and may mean you won’t get the maximum benefit from your medication.

Street drugs

There are many different street drugs, but we don’t know what effect taking them with valproate will have, so it’s best to be cautious. Taking them together could result in the risk of overdose as well as other dangers like blacking out and not remembering what you have done. There is no regulation of street drugs or ‘legal highs’, so even if there are no known issues with the medication you take, the supply you receive might be mixed with other substances that could be dangerous.

Get more advice on our drugs and alcohol guide.

There are multiple companies that manufacture this medicine and the non-active ingredients may vary between products and also between the different strengths of tablets that are available.

Always let your pharmacist know if you have any food allergies or intolerances, and always check with them if you’re concerned about any of the ingredients in your medication.

Liquid formulations contain sorbitol and saccharin, while the syrup additionally contains sugar and should be avoided if you have diabetes.

If you need to avoid animal products, please note that non-active ingredients used in the production of medicines may sometimes be of animal origin. Ask your pharmacist if you have any questions about the ingredients.

Further information about practical considerations for medicines if you need to avoid animal products can be found on the Vegan Society website.

You may feel sleepy, confused or dizzy when you start taking valproate, which may affect your concentration when doing things like driving a car or riding a bike.

It might be best to stop driving, riding a bike or doing anything that requires a lot of focus for the first few days or weeks until you know how it affects you.

Most people drive as normal while taking valproate. If you are worried about this or have any concerns you would like to discuss, speak to your doctor or pharmacist.

You must tell The DVLA (Driver and Vehicle Licensing Agency) if you have bipolar disorder, schizophrenia, schizoaffective disorder or other mental health conditions that could affect your driving. You can be fined if you do not tell The DVLA about a medical condition that affects your driving and may be prosecuted if you are involved in an accident as a result.

Pregnancy

It is not safe to take valproate during pregnancy. It can be harmful to developing babies during pregnancy and cause a condition called Fetal Valproate Syndrome ( FVS) which can cause physical birth defects and lifelong learning and behaviour changes.

It is recommended that if you can get pregnant and are taking valproate, you must use an effective method of contraception as part of the Valproate Pregnancy prevention Programme to reduce the risk of unplanned pregnancy.

If you are prescribed valproate, talk to your doctor if you are planning to have a family so you can discuss treatment options that are best for you and your baby. Do not stop using contraception until you and your specialist have agreed on what treatment option would be best for you. They are likely to need to change you to another medicine and carefully stop your valproate.

However, if you become pregnant while you are on valproate, you should carry on taking it and make an urgent appointment to see your doctor. They can discuss the benefits and risks of continuing valproate and help you to make a decision that is best for you and your baby.

They may refer you to a specialist perinatal mental health team to support you with this decision.

You can find out more information about taking valproate during pregnancy at Bumps (Best Use of Medicines in Pregnancy).

If you are planning to get pregnant, it is recommended that you take folic acid while you are trying for a baby and during pregnancy.

Post-natal

Some newborn babies whose mothers take valproate during pregnancy can get withdrawal symptoms at birth and soon after, like feeding difficulties or restlessness.

Tell your midwife if you are taking valproate, so that they can help if the baby has any symptoms after birth.

Breastfeeding

Valproate is passed to the baby in breastmilk in small amounts.
If your baby was born early, then breastfeeding while you are taking valproate may not be recommended. Talk to your midwife and doctor about feeding options.

Tell your midwife if you are taking valproate, so that they can help if the baby has any symptoms after birth.

It’s important to remember that breastfeeding is not a form of contraception and you can get pregnant during this time. If you are taking valproate and breastfeeding, use a form of contraception. Speak to your doctor or midwife for advice.

Sex

Valproate can have side effects that may affect your sex life. These include:

• breast growth (regardless of gender)
• gaining weight, temporary hair loss or acne, which may affect your confidence and therefore your desire to have sex

Talk to your doctor if you get these symptoms.

Untreated illness can have a negative effect on your sex life, so if valproate helps you to recover, positive effects can include improving your desire, experience and enjoyment of intermit relationships again.

Fertility

Valproate has been shown to reduce fertility or cause infertility in men. This can be reversed if valproate is stopped.

If you are taking valproate, or have taken it in the last few months, when you conceive there might be an increased risk of your child having a neurodevelopmental disorder like autism, ADHD or a learning disability. More research is being done to understand this better.

Valproate can cause polycystic ovary syndrome (PCOS), which can lead to future infertility.

Valproate should not be taken by anyone who can get pregnant unless they are on the Valproate Pregnancy Prevention Programme (Prevent).

If you want to start a family and are taking valproate, you must speak to your doctor about your treatment options. Do not stop taking your contraception until you have spoken with them.

Valproate is not a banned substance in sport.

Most people play sports as normal while taking valproate, but if valproate affects your concentration, eyesight or co-ordination, then you may want to wait to see if those effects go away before playing sports that need a lot of focus. If you have any concerns, discuss this with your doctor.

Valproate may affect your concentration, make you feel sleepy or make it harder to remember things.

Ideally it is best not to take valproate for the first time just before your exams.

It is not possible to predict how the medication will make you feel, and if you do get any side effects, these are more likely to occur when you first start taking valproate.

You should talk to your doctor about any future exams if you are starting valproate. You might decide together to delay starting it until you have done them. If they are more than a month away, however, you might find that it is better to start valproate to improve your motivation to study.

Most people take exams as normal while taking valproate, but if you have concerns, discuss this with your doctor.