Background. Evidence is accruing regarding the risks of valproate exposure in women of childbearing age. Recommendations have recently been made for a higher standard of prenatal counselling and prescribing practice in respect of valproate use in this patient group.Aim and Method. A reaudit was carried out to review the standard of clinical discussion around teratogenic risk and pregnancy planning offered to women of child-bearing age prescribed valproate. Case notes and prescription charts of women 45 years old or less were examined and compared with the results of a previous audit in 2005.Results. The use of valproate was increased overall by 64% and there was an 18% increase in off-label valproate use. The rate of clinical discussion carried out during commencement declined from 70% to 35% and at annual review from 50% to 22%. There was less clinical discussion in outpatients and in older patients. More than 40% of doctors surveyed were not confident about giving information to women.Clinical Implication. There is a need for a multidisciplinary approach and action at Healthcare Trust level, to increase awareness and reduce risks associated with valproate prescribing in childbearing women.
IntroductionAgomelatine is a novel antidepressant which was licensed in the United Kingdom in February 2009, but has not yet been included in national prescribing guidelines in the UK. The cost of Agomelatine and the need for monitoring of liver function during treatment have informed the development of strict local guidelines in respect of the initiation of Agomelatine.ObjectiveTo assess the use of Agomelatine following introduction in a district general hospital outpatient setting.AimsTo determine whether Agomelatine use is in accordance with recently formulated local guidelines and to explore prescribing patterns for Agomelatine.MethodCase notes were reviewed for consecutive patients prescribed Agomelatine over a 3 month study period. Using a specifically designed proforma, prescribing data, laboratory indices, outcome data and patient feedback were assessed against standards derived by consensus based on new prescribing guidelines.Results27 patients were studied. Agomelatine was initiated in 93% of cases for major depressive disorder as third-line treatment. 89% of patients completed baseline liver function tests and 63% had these reviewed at all of 3 time-points as recommended. 14% did not require an increment to the 50mg dose. 33% discontinued Agomelatine. 44% experienced mild side-effects such as headaches and nausea. 56% did not require an additional anxiolytic and 14% were successfully discharged. Positive feedback was obtained verbally and with rating scales.ConclusionsInitiation of agomelatine in accordance with recommended standards proved possible in a district general hospital setting. Agomelatine was well tolerated and positive patient feedback was received.
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