Who Is Prescribed Valproate and How Carefully Is This Treatment Reviewed in UK Mental Health Services? Data From a Clinical Audit

Authors

Carol Paton, Prescribing Observatory for Mental Health, Centre for Quality Improvement, Royal College of Psychiatrists, 21 Prescot Street, Whitechapel, London E1 8BB, UK.
Leslie Citrome, Department of Psychiatry and Behavioural Sciences, New York Medical College, New York, USA.
Emilio Fernandez-Egea, Department of Psychiatry and Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK.
Olivia Rendora, Prescribing Observatory for Mental Health, Centre for Quality Improvement, Royal College of Psychiatrists, London, UK.
Thomas R. Barnes, Division of Psychiatry, Imperial College London, London, UK.

Author Type(s)

Faculty

DOI

10.1177/20451253221110016

Journal Title

Therapeutic Advances in Psychopharmacology

First Page

20451253221110016

Document Type

Article

Publication Date

1-1-2022

Department

Psychiatry and Behavioral Sciences

Abstract

BACKGROUND: The licensed indications for valproate are narrow, yet this medication is commonly prescribed in mental health services. OBJECTIVES: To explore the target symptoms/behaviours for which valproate is prescribed and how well the efficacy and tolerability of this treatment are monitored in routine clinical practice. DESIGN: An audit-based quality improvement (QI) programme in UK mental health services. METHODS: Information on valproate prescribing was collected from clinical records using a bespoke data collection tool. RESULTS: Sixty-four NHS mental health Trusts/healthcare organisations submitted data on valproate treatment for 5320 patients. Valproate was clearly prescribed for a licensed indication in 1995 (38%) patients, off-label in 1987 (37%) while the indication was uncertain/not available in 1338 (25%). Of the 919 patients started on valproate treatment within the past year, between a half and two-thirds had each of the relevant baseline physical health checks documented. In 539 (59%) of these patients, valproate was prescribed for an unlicensed indication; the prescription was recognised as off-label in 363 (67%), 20 (6%) of whom were documented as having had this explained to them. Of 631 patients prescribed valproate for between 3 months and a year, early on-treatment assessments of response and side effects were documented in 441 (70%) and 332 (53%), respectively. Of 4401 patients treated for more than a year, annual on-treatment reviews of clinical response and side effects were documented in 2771 (63%) and 2140 (49%), respectively. CONCLUSION: Our data suggest the majority of prescriptions for valproate in mental health services are not for a licensed indication. Furthermore, patients rarely receive an explanation that their valproate prescription is off-label, perhaps partly because the licensed indications are not widely understood by prescribers. Given the very limited evidence for efficacy for the off-label uses of valproate, failure to routinely conduct early on-treatment and annual reviews of the benefits and side effects of this medication may result in patients remaining on ineffective and poorly tolerated treatment by default.

Recommended Citation

Paton, C., Citrome, L., Fernandez-Egea, E., Rendora, O., & Barnes, T. R. (2022). Who Is Prescribed Valproate and How Carefully Is This Treatment Reviewed in UK Mental Health Services? Data From a Clinical Audit. Therapeutic Advances in Psychopharmacology, 12, 20451253221110016. https://doi.org/10.1177/20451253221110016