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Valproate Discovery Pregnancy — RACP Adult Medicine MCQ

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HardGeneral Internal MedicineValproate Discovery PregnancyRACP Adult Medicine

A 38-year-old woman with JME on valproate discovers she is 8 weeks pregnant (unplanned). She has failed lamotrigine and LEV. Management?

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Correct answer: C — Reduce to lowest effective dose; urgent neurology/obstetric consultation; detailed foetal scanning

Reduce valproate to minimum effective dose (ideally <600 mg/day). Folic acid 5 mg. Urgent specialist input. Abrupt cessation risks status epilepticus.

Reference: TGA – 2024; eTG – 2025 – Neurology; AMH – 2025