ReviewInternational journal of clinical pharmacy2025
Comparative efficacy and safety of alternatives to sodium valproate in the management of bipolar affective disorder in people of child-bearing age: a narrative review by the European Society of Clinical Pharmacy's mental health specialist interest group.
Review in International journal of clinical pharmacy, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
4 citing papers in PubMed.
- Clinical characteristics and risk factors of antipsychotic-associated metabolic syndrome in bipolar disorder: a retrospective analysis.BMC psychiatry · 2026Article
- State-of-the-art treatment of postpartum bipolar disorder.Current opinion in psychiatry · 2026Review
- Clinical prediction of sodium valproate-induced movement disorders in hospitalized patients: a nomogram-based model using real-world data.International journal of clinical pharmacy · 2025Article
- Correction: European Society of Clinical Pharmacy: 5 steps of medication safety-medication without harm, where are we now?International journal of clinical pharmacy · 2025Article
Corrections and comments
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Authors and funding
13 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe European Medicines Agency has recommended a series of restrictions on the use of sodium valproate (valproate) following research linking its exposure in utero to adverse congenital and neurodevelopmental effects in offspring. Recent research has highlighted a potential increased risk of neurodevelopmental disorders in children born to males taking valproate prior to conception. Clinicians and patients require guidance regarding suitable alternatives.
aimTo provide an overview of suitable alternatives to valproate in the management of bipolar disorder.
methodA narrative review was conducted. Only medications with an established evidence base in managing different phases of bipolar disorder and endorsed within clinical practice guidelines were considered. Eligible guidelines included those (i) where recommendations were informed by a formal guideline development process and (ii) published in English within the last 15 years. REPROTOX® was chosen as the primary information source regarding reproductive safety of alternative medications.
resultsOf all second-generation antipsychotics, quetiapine should be considered a first-line alternative to valproate. Lithium has been associated with an increased risk of cardiac malformations, especially Ebstein anomaly, following in utero exposure. However, given its robust efficacy as an antimanic agent and the absolute risk of cardiac abnormalities being low, it's use can still be considered in individuals of child-bearing potential with appropriate monitoring. Carbamazepine treatment should be avoided due to concerns for teratogenicity. Although considered safe in pregnancy, lamotrigine is largely effective at preventing relapse of bipolar depression. Thus, lamotrigine offers limited clinical utility as an alternative to valproate.
conclusionSpecific recommendations are made regarding alternatives to valproate in managing bipolar disorder.
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Registered trials
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