Contraceptive Advice: Valproate Medicines
Updated June 2020
What's new?
A previous blog Drug Safety Information: valproate medicines highlighted the MHRA valproate medicines safety alert April 2018 regarding women taking valproate medicines.
The Valproate Pregnancy Prevention Programme (Prevent) Guide for Healthcare Professionals was updated in November 2019 and includes a change to the recommendations for progestogen-only injections. Progestogen-only injections may now be considered as “highly effective” if repeat injections are documented as having been administered on schedule by a healthcare professional. The other highly effective methods of contraception are detailed in Table 1 below. These methods have a failure rate of less than 1%.
Further information on changes to the Guide for Healthcare Professionals can be found here.
This updated blog 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.
Progestogen-only injections may also now be considered as “highly effective” if repeat injections are documented as having been administered on schedule by a healthcare professional. When administered at the recommended dosing interval, the failure rate of progestogen-only injectable contraception is approximately 0.2% in the first year of use. With typical use, the failure rate is approximately 6% (this may be due to repeat injections being administered late). Figures are available from https://www.fsrh.org/standards-and-guidance/documents/cec-ceu-guidance-injectables-dec-2014/.
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
Where can women using valproate obtain advice and contraception?
Women can obtain advice on contraception from their GP. 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. To ensure prioritised access, the 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 0141 211 8130.
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.
Originally published 29/10/18 and updated on 08/06/20. Medicines Update blogs are correct at the time of publication