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

J 2025

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

FITZGERALD, Ita; Izgi BAYRAKTAR; Birgit EIDEN; Rosalind GITTINS; Erica MAGNI et al.

Základní údaje

Originální název

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

Autoři

Vydání

INTERNATIONAL JOURNAL OF CLINICAL PHARMACY, NETHERLANDS, SPRINGER, 2025, 2210-7703

Další údaje

Jazyk

angličtina

Typ výsledku

Článek v odborném periodiku

Obor

30104 Pharmacology and pharmacy

Stát vydavatele

Nizozemské království

Utajení

není předmětem státního či obchodního tajemství

Odkazy

URL

Impakt faktor

Impact factor: 3.200 v roce 2024

Označené pro přenos do RIV

Ano

Kód RIV

RIV/00216224:14160/25:00143920

Organizační jednotka

Farmaceutická fakulta

Klíčová slova anglicky

Bipolar affective disorder; Bipolar disorder; Mood stabilisers; Narrative review; Pregnancy; Sodium valproate; Teratogenicity

Štítky

rivok

Příznaky

Mezinárodní význam, Recenzováno

Změněno: 10. 3. 2026 10:47, Mgr. Irena Doubková

Anotace

V originále

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 (R) 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.

Citovat

FITZGERALD, Ita; Izgi BAYRAKTAR; Birgit EIDEN; Rosalind GITTINS; Erica MAGNI; Marie HUMBERT-CLAUDE; Lara-Turiya MOLITSCHNIG; Paula DARM; Anna WAKSMUNDZKA-WALCZUK; Nikolaus RIESENHUBER; Matej STUHEC; Ivana TAŠKOVÁ a Martina HAHN. 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. INTERNATIONAL JOURNAL OF CLINICAL PHARMACY. NETHERLANDS: SPRINGER, 2025, roč. 47, č. 3, s. 666-675. ISSN 2210-7703. Dostupné z: https://doi.org/10.1007/s11096-025-01919-x.

@article{2559441,
   author = {Fitzgerald, Ita and Bayraktar, Izgi and Eiden, Birgit and Gittins, Rosalind and Magni, Erica and HumbertandClaude, Marie and Molitschnig, LaraandTuriya and Darm, Paula and WaksmundzkaandWalczuk, Anna and Riesenhuber, Nikolaus and Stuhec, Matej and Tašková, Ivana and Hahn, Martina},
   article_location = {NETHERLANDS},
   article_number = {3},
   doi = {https://doi.org/10.1007/s11096-025-01919-x},
   keywords = {Bipolar affective disorder; Bipolar disorder; Mood stabilisers; Narrative review; Pregnancy; Sodium valproate; Teratogenicity},
   language = {eng},
   issn = {2210-7703},
   journal = {INTERNATIONAL JOURNAL OF CLINICAL PHARMACY},
   title = {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},
   url = {https://link.springer.com/article/10.1007/s11096-025-01919-x?utm_source=getftr&utm_medium=getftr&utm_campaign=getftr_pilot&getft_integrator=clarivate},
   volume = {47},
   year = {2025}
}

TY  - JOUR
ID  - 2559441
AU  - Fitzgerald, Ita - Bayraktar, Izgi - Eiden, Birgit - Gittins, Rosalind - Magni, Erica - Humbert-Claude, Marie - Molitschnig, Lara-Turiya - Darm, Paula - Waksmundzka-Walczuk, Anna - Riesenhuber, Nikolaus - Stuhec, Matej - Tašková, Ivana - Hahn, Martina
PY  - 2025
TI  - 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
JF  - INTERNATIONAL JOURNAL OF CLINICAL PHARMACY
VL  - 47
IS  - 3
SP  - 666-675
EP  - 666-675
PB  - SPRINGER
SN  - 22107703
KW  - Bipolar affective disorder
KW  - Bipolar disorder
KW  - Mood stabilisers
KW  - Narrative review
KW  - Pregnancy
KW  - Sodium valproate
KW  - Teratogenicity
UR  - https://link.springer.com/article/10.1007/s11096-025-01919-x?utm_source=getftr&utm_medium=getftr&utm_campaign=getftr_pilot&getft_integrator=clarivate
N2  - 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 (R) 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.
ER  -

FITZGERALD, Ita; Izgi BAYRAKTAR; Birgit EIDEN; Rosalind GITTINS; Erica MAGNI; Marie HUMBERT-CLAUDE; Lara-Turiya MOLITSCHNIG; Paula DARM; Anna WAKSMUNDZKA-WALCZUK; Nikolaus RIESENHUBER; Matej STUHEC; Ivana TAŠKOVÁ a Martina HAHN. 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. \textit{INTERNATIONAL JOURNAL OF CLINICAL PHARMACY}. NETHERLANDS: SPRINGER, 2025, roč.~47, č.~3, s.~666-675. ISSN~2210-7703. Dostupné z: https://doi.org/10.1007/s11096-025-01919-x.

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