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Medication Formulations — MRCPsych Paper B MCQ

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EasyIntellectual DisabilityMedication FormulationsMRCPsych Paper B

A 39-year-old man with moderate intellectual disability and generalised epilepsy has been established on sodium valproate gastro-resistant tablets for several years with good seizure control. His support workers report that he now consistently spits out or refuses the tablets because he cannot swallow them. Renal and hepatic function are normal and he has no dysphagia for food or fluids. Which formulation should be considered?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Licensed sodium valproate oral liquid

Explanation lettering: D = shown as A · A = shown as B · E = shown as C · C = shown as D · B = shown as E

B is correct. A licensed UK sodium valproate oral liquid (200 mg/5 ml) is available for oral administration in epilepsy, so an effective drug with good seizure control can be continued in an equivalent daily dose rather than switched to another antiseizure medication. The decisive stem feature is inability to swallow solid dose forms, not the intellectual disability itself. A and C fail because gastro-resistant and controlled-release valproate tablets must be swallowed whole and not crushed or chewed; altering them destroys the release characteristics and risks dose dumping or loss of control. D and E fail because no licensed rectal or transdermal sodium valproate maintenance formulation exists in the UK. When switching, specify product, strength and concentration clearly and involve carers to avoid dosing error.

Reference: Electronic Medicines Compendium (emc), Sanofi. Epilim Liquid 200 mg/5 ml – Summary of Product Characteristics, sections 2 and 4.2 (current version, 2025). https://www.medicines.org.uk/emc/product/517/smpc