NHS Greater Glasgow & Clyde Area Drug and Therapeutics Committee
Greater Glasgow and Clyde Medicines
Medicines Update

Contraceptive Advice: Valproate Medicines

Background

A previous blog Drug Safety Information: valproate medicines highlighted the MHRA valproate medicines safety alert April 2018 regarding women taking valproate medicines. This article gives local expert advice to assist decision making on contraceptive methods in the context of the MHRA recommendations and also gives advice on where female patients can obtain advice and contraception within NHSGGC.

Which contraceptive methods are recommended?

Female patients of childbearing potential who are prescribed valproate must use at least one effective method of contraception without interruption during the entire duration of treatment with valproate. Individual circumstances should be evaluated in each case when choosing the contraception method, involving the patient in the discussion to guarantee her engagement and compliance with the chosen measures. Even if she has amenorrhoea she must follow all the advice on effective contraception.

Highly effective contraception

A highly effective user independent contraceptive choice should be considered first line – see table 1 below for a summary or click here for full Faculty of Sexual Health and Reproductive Healthcare guidance.

Table 1 - Highly effective user independent contraceptive choices

Method

% patients experiencing an unintended pregnancy within the first year of use with typical use

Copper-bearing intrauterine device (Cu-IUD)

0.8

Levonorgestrel-releasing intrauterine system (LNG-IUS)

0.2

Progestogen-only implant (IMP)

0.05

Female sterilisation

0.5

Alternative methods of contraception

If, after individual discussion, none of the above methods are suitable then two complementary forms of contraception are recommended. Example regimes would include one form from the following list in combination with a suitable barrier method

  • combined oral contraceptive pill
  • progestogen-only pill.
  • transdermal patch
  • vaginal ring
  • injectable contraception

Where can women using valproate obtain advice and contraception?

Women can attend their GP surgery for advice on contraception. There are no significant drug interactions between valproate and hormonal contraceptives. For some women, depending on medical complexity or the contraceptive method chosen, referral by the GP to specialist sexual health services will be required. In NHSGGC the specialist service is Sandyford Sexual Health Services

Clinicians wishing advice about appropriate contraception in women using valproate are encouraged to phone Sandyford’s professional helpline 0141 211 8646 or for more information click here.

Where women using valproate are referred to Sandyford, it has been agreed that these patients will be prioritised. They will be offered an urgent appointment slot if able to attend at short notice, and they should not have to wait more than a month for a routine appointment. To ensure prioritised access, referring GP or the woman themselves must identify themselves as using valproate.

GP referrals to Sandyford for contraception can be made by phoning the professional helpline 0141 211 8646 or via SCI gateway. Women can self-refer to Sandyford by phoning 01412118130.

GP referrals for female sterilisation should be directed to hospital gynaecology via SCI Gateway.

For more advice on contraceptive prescribing in primary care in NHSGGC please click the staffnet link here to access guidance.

 

Written by Dr Louise Melvin, Consultant in Sexual and Reproductive Health, Sandyford

Published 29/10/18