Patterns in Psychiatrists’ Prescription of Valproate for Female Patients of Childbearing Age With Bipolar Disorder in Japan: A Questionnaire Survey

Tachibana, Masumi; Hashimoto, Tasuku; Tanaka, Mami; Watanabe, Hiroyuki; Sato, Yasunori; Takeuchi, Takashi; Terao, Takeshi; Kimura, Shou; Kôyama, Akio; Ebisawa, Sachie; Shizu, Yuichiro; Nagase, Teruyoshi; Hirakawa, Junichi; Hatta, Kotaro; Nakazato, Michiko; Iyo, Masaomi

doi:10.3389/fpsyt.2020.00250

“…Nevertheless, there was no significant discrepancy in the frequency of valproate prescriptions between young women and other groups in this study. This result may be supported by a previous study [ 28 ] that surveyed Japanese psychiatrists' attitudes toward prescribing valproic acid to women of childbearing age, which lacked data on actual valproic acid prescription but reported that Japanese psychiatrists often prescribe valproic acid to women of childbearing age. The previous study [ 28 ] also reported that psychiatrists working at general hospitals tended to refrain from prescribing valproate to childbearing-aged female compared to those affiliated with other medical facilities, such as psychiatric hospitals and private clinics.…”

Section: Discussionsupporting

confidence: 62%

“…This result may be supported by a previous study [ 28 ] that surveyed Japanese psychiatrists' attitudes toward prescribing valproic acid to women of childbearing age, which lacked data on actual valproic acid prescription but reported that Japanese psychiatrists often prescribe valproic acid to women of childbearing age. The previous study [ 28 ] also reported that psychiatrists working at general hospitals tended to refrain from prescribing valproate to childbearing-aged female compared to those affiliated with other medical facilities, such as psychiatric hospitals and private clinics. Little chances and experience of psychiatrists working at clinics in consulting for pregnant female with psychiatric diseases might increase their valproate prescription to women of childbearing age.…”

Section: Discussionsupporting

confidence: 62%

Effect of age and sex on prescriptions for outpatients with bipolar disorder in the MUSUBI study: a cross‑sectional study

Kawamata

¹

,

Yasui‐Furukori

²

,

Adachi

³

et al. 2022

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Background Childbearing-aged female patients and elderly patients with bipolar disorder need special attention for pharmacological treatments, but current guidelines provide little information on their pharmacological treatment. In particular, the risk/benefit balance of pharmacological treatment for childbearing-aged females with bipolar disorder is a growing concern. Therefore, we aimed to address the effect of age and sex on psychotropic drug prescription for outpatients with bipolar disorder. Methods The MUlticenter treatment SUrvey for BIpolar disorder in Japanese psychiatric clinics (MUSUBI) study was conducted, and data on age, sex, and details of pharmacological treatment were collected. Results A total of 3106 outpatients were included in this study. Among young females (age ≤ 39), 25% were prescribed valproate. There was no significant difference in the frequency and daily dose of valproate prescription for young females among all groups. Valproate prescriptions were significantly less frequent among young males and more frequent among middle-aged males. Lithium prescriptions were significantly less frequent among young females and more frequent among older males (age ≥ 65) and older females. Lamotrigine prescriptions were significantly more frequent among young males and young females and less frequent among older males and older females. Carbamazepine prescriptions were significantly less frequent among young males and more frequent among older males. Conclusions Biased information about the risk and safety of valproate and lithium for young females was suggested, and further study to correct this bias is needed. Older patients were prescribed lithium more commonly than lamotrigine. Further studies are needed to determine the actual pharmacotherapy for elderly individuals.

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“…Nevertheless, there was no signi cant discrepancy in the frequency of valproate prescriptions between young women and other groups in this study. This result may be supported by a previous study (27) that surveyed Japanese psychiatrists' attitudes toward prescribing valproic acid to women of childbearing age, which lacked data on actual valproic acid prescription but reported that Japanese psychiatrists often prescribe valproic acid to women of childbearing age. This nding supports the reported awareness of the high incidence of valproic acid prescription by Japanese psychiatrists to women of childbearing age.…”

Section: Discussionsupporting

confidence: 56%

Effect of age and sex on prescriptions for outpatients with bipolar disorder in the MUSUBI study: a cross‑sectional study

Kawamata

¹

,

Yasui‐Furukori

²

,

Adachi³

et al. 2022

Preprint

0

View full text Add to dashboard Cite

Background Childbearing-aged female patients and elderly patients with bipolar disorder need special attention for pharmacological treatments, but current guidelines provide little information on their pharmacological treatment. In particular, the risk/benefit balance of pharmacological treatment for childbearing-aged females with bipolar disorder is a growing concern. Therefore, we aimed to address the effect of age and sex on psychotropic drug prescription for outpatients with bipolar disorder. Methods The MUlticenter treatment SUrvey for BIpolar disorder in Japanese psychiatric clinics (MUSUBI) study was conducted, and data on age, sex, and details of pharmacological treatment were collected. Results A total of 3106 outpatients were included in this study. Among young females (age ≤ 39), 25% were prescribed valproate. There was no significant difference in the frequency and daily dose of valproate prescription for young females among all groups. Valproate prescriptions were significantly less frequent among young males and more frequent among middle-aged males. Lithium prescriptions were significantly less frequent among young females and more frequent among older males (age ≥ 65) and older females. Lamotrigine prescriptions were significantly more frequent among young males and young females and less frequent among older males and older females. Carbamazepine prescriptions were significantly less frequent among young males and more frequent among older males. Conclusions Biased information about the risk and safety of valproate and lithium for young females was suggested, and further study to correct this bias is needed. Older patients were prescribed lithium more commonly than lamotrigine. Further studies are needed to determine the actual pharmacotherapy for elderly individuals.

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“…Other safe prescribing bodies also concurred with these guidelines and the potential teratogenic effects of valproate such as the British National Formulary, European Pharmacovigilance Risk Assessment Committee (PRAC), Coordination Group for Mutual Recognition and Decentralised Procedures-Human (CMDh), and the International College of Neuro-Psychopharmacology treatment guidelines for Bipolar Disorder in adults (CINP-BD-2017)). 18 , 19 , 20 In addition, in September 2018, the South African Department of Health issued a notice ‘Sodium Valproate Unsafe in Pregnancy’ 21 and the SAHPRA letter was updated in 2019, stating that valproate should be avoided in pregnancy and in women of childbearing potential. 7 , 16…”

Section: Introductionmentioning

confidence: 99%

The valproate prescription pattern for female mental healthcare users of reproductive age

Gasa,

Tomita,

Juby

et al. 2024

South African Journal of Psychiatry

0

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Background: Sodium valproate (valproate) that is used both as an anti-epileptic and a mood stabiliser is teratogenic in pregnancy. A Dear Health Care Professional Letter (DHCPL) issued in December 2015 recommended the avoidance of sodium valproate prescription in women of childbearing age (WOCBA) and pregnant women.Aim: This study aimed to describe the prescription pattern of valproate in female mental healthcare users (MHCUs).Setting: Regional hospital psychiatry department in King Dinizulu Hospital Complex, Durban, KwaZulu-Natal.Methods: This was a descriptive, retrospective chart review of female in- and out-patient aged 12–55 years who were receiving a valproate prescription for mental illness between 01 January 2018 and 31 December 2020.Results: Of the 158 females who received valproate during the study period, 15 (9.5%) had it tapered off while 143 (90.5%) were continued. Only 19% of all the patients had documented counselling regarding valproate, 19 (12%) had documented contraceptive use, and six (3.8%) continued its use at any point during pregnancy. The most frequently prescribed dose range was 800 mg – 1499 mg/day (n = 111, 70.7%) and the most common psychiatric indication was a psychotic disorder.Conclusion: This study showed that prescription of valproate in female MHCUs still occurs in practice in a referral centre in South Africa despite the guidelines outlining management of those of reproductive age on valproate. The prescription pattern and monitoring of valproate were poorly documented in relation to the guideline.Contribution: This study highlights the lack of adherence to recommendations regarding the prescription of valproate in WOCBA and the need for improved documentation of the indications, consent and counselling.

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Patterns in Psychiatrists’ Prescription of Valproate for Female Patients of Childbearing Age With Bipolar Disorder in Japan: A Questionnaire Survey

Cited by 6 publications

References 31 publications

Effect of age and sex on prescriptions for outpatients with bipolar disorder in the MUSUBI study: a cross‑sectional study

Effect of age and sex on prescriptions for outpatients with bipolar disorder in the MUSUBI study: a cross‑sectional study

Effect of age and sex on prescriptions for outpatients with bipolar disorder in the MUSUBI study: a cross‑sectional study

The valproate prescription pattern for female mental healthcare users of reproductive age

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