skip to main content

Valproate and unplanned pregnancy — GPhC CRA MCQ

Instant feedback + full explanation. One question, done properly.

HardAdverse Drug ReactionsValproate and unplanned pregnancyGPhC CRA

A 42-year-old woman taking sodium valproate 500 mg twice daily presents to the pharmacy. She has recently found out she is pregnant at eight weeks' gestation. She is extremely anxious. What is the most appropriate immediate action?

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

Reveal the answer and explanation

Correct answer: E — Advise her to continue valproate and refer urgently to her GP and neurology team for an immediate specialist review, as abrupt withdrawal is dangerous but continued use carries significant teratogenic risk

This is a complex clinical situation. Sodium valproate carries the highest teratogenic risk of all AEDs, but abrupt withdrawal can cause rebound seizures which also pose a significant risk to the mother and foetus. The patient should be referred urgently to her GP and specialist team for an immediate review. She should not stop valproate abruptly. High-dose folic acid (5 mg) should also be started, although the critical period for neural tube development has largely passed by eight weeks. The decision to switch must be made by a specialist.

Reference: BNF; MHRA Valproate Pregnancy Prevention Programme; NICE NG217