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Valproate in Women — MRCPsych Paper B MCQ

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ModerateIntellectual DisabilityValproate in WomenMRCPsych Paper B

A 30-year-old woman with mild intellectual disability and bipolar disorder is prescribed sodium valproate 1000 mg daily. She has capacity to make this treatment decision when information is provided in an accessible format. She is able to become pregnant, is not using effective contraception and is not enrolled in the valproate Pregnancy Prevention Programme. A pregnancy test is negative. What is the most appropriate immediate management?

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

Reveal the answer and explanation

Correct answer: E — Arrange prompt specialist review, continue valproate meanwhile, and address the Pregnancy Prevention Programme or supervised withdrawal

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

The correct answer is B. Valproate must not be prescribed to a woman able to become pregnant unless other treatments are unsuitable and the Pregnancy Prevention Programme requirements are met. She therefore needs prompt specialist review, with accessible discussion of teratogenic and neurodevelopmental risks, effective contraception, the required risk acknowledgement documentation and alternative treatments. If continued valproate is not justified or she does not meet the programme conditions, gradual supervised withdrawal and an alternative treatment should be planned. She should not stop valproate abruptly while awaiting review because bipolar disorder may relapse. Deferring review (A) leaves an immediate reproductive risk unmanaged. Dose escalation (C) does not address that risk. Lithium (D) may be considered as an alternative but should not simply be added. Immediate substitution with carbamazepine (E) is unsafe and bypasses specialist planning.

Reference: Medicines and Healthcare products Regulatory Agency. Valproate: updated safety and educational materials to support patient discussion on reproductive risks. Drug Safety Update, 10 June 2025. https://www.gov.uk/drug-safety-update/valproate-belvo-convulex-depakote-dyzantil-epilim-epilim-chrono-or-chronosphere-episenta-epival-and-syonellv-updated-safety-and-educational-materials-to-support-patient-discussion-on-reproductive-risks