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Is the MHRA’s hardline stance on valporate really justified?

02 May 2018

The Government’s intervention on valporate prescribing feels like a step too far, says The Pharmacist’s GP blogger Dr Livingstone

If there’s one thing that riles the average GP – OK, true, there isn’t one thing, there are loads, but bear with me – it’s any kind of imposition on our prescribing. Admittedly, the status of the prescription pad has been diluted over the years as various Noctors (a delightful term for someone who is not a doctor) have acquired prescribing rights. Nonetheless, it remains a powerful symbol of GP authority and therefore any fiddling about with the prescribing process risks provoking in us a major flounce.

And so it is with valproate. Suddenly, the Medicines and Healthcare products Healthcare Authority (MHRA) has come over all draconian about this drug. Apparently, GPs have got to identify and refer for specialist assessment all women of childbearing age taking it. We must stop prescribing it for bipolar disorder and migraine.

And it’s ‘banned’ in epilepsy unless the patient is on a ‘specific programme to prevent pregnancy’ – no idea what ‘ban’ means exactly, but I can tell you that a ‘specific programme to prevent pregnancy’ involves the patient signing a risk acknowledgement form and undertaking regular pregnancy tests before, during and after treatment. Just in case you were wondering.

Which makes me think:

  1. Blimey
  2. What’s the big deal, because we’ve been aware of, and acting on, this issue for years?
  3. This seems a random and heavy-handed approach, and other teratogenic drugs are available, so are we to anticipate similar clampdowns for them?
  4. If the MHRA is going to come across like a police-prescribing state, how are they going to, er, police this?
  5. I’m a professional, isn’t safe prescribing part of my job description and so something that does not require outside interference?

Still, it’s an ill wind. Doubtless you pharmacists will be getting a forbidding communique from the MHRA instructing you only to dispense the drug if you’re wearing full riot gear. But at least you can seize the moment to do an Medicines Use Review (MUR) and flog some pregnancy tests.

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