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It accepts unpublished works on psychiatry and mental health, and its medical and social repercussions. For this reason, space is provided in the Journal for works in the biological, clinical and psychosocial field. Manuscripts are evaluated, before being accepted, by external reviewers (peer-review). The recommendations consisted of the following points:(1)Valproic acid should not be used to treat epilepsy or bipolar disorder in female children and in pregnant women and women of childbearing potential unless other treatments have been ineffective or have not been tolerated.

In women for whom valproic acid is the only possible option after having tried other drugs, effective contraceptive measures must be used, and the commencement and supervision of the treatment must be handled by physicians with experience in treating these disorders. The physicians that prescribe valproic acid to this population must provide the individuals with complete and understandable information about the risk of congenital malformations and developmental disorders in offspring to facilitate informed decision-making.

Valproic acid must not be used in the treatment for preventing migraines. Likewise, the PRAC recommended carrying out studies at the European level to establish the efficacy of these measures. Medication phorum and Drug Administration (FDA) had already issued a warning, in June 2011,6 Terbutaline Sulfate (Terbutaline Sulfate)- Multum the risk there Amoxapine Tablets (Amoxapine)- FDA that children having prenatal exposure to valproic acid (in addition to the acknowledged congenital malformations) would obtain lower scores on cognitive testing compared with children exposed to other anti-seizure drugs.

The FDA also indicated that the benefits and risks should be carefully considered before using valproic acid in women of childbearing potential, recommending that other drugs should be used unless valproic acid was essential for that specific individual (risk of injury or death).

If the drug was used, the agency suggested that effective birth control measures should be used. With respect to cognitive alterations, there have been descriptions of both delay in language acquisition11,16 and lower Tranylcypromine (Parnate)- FDA in infancy (from 6 to 10 points), Clindamycin Topical (Cleocin T)- Multum the verbal scale being the most Clindamycin Topical (Cleocin T)- Multum. As for ADHD, Cohen et al.

Some studies found a dose-dependent effect, suggesting that valproic acid has a toxic effect on neurodevelopment. In the case of bipolar disorder, shared clinical decision24 to begin or maintain treatment with valproic acid is based on the result of balancing the benefits (avoiding relapses or flare-ups, with the consequent risks for the mother and the foetus) and the previously indicated risks for the offspring.

All of us, the bone marrow transplantation journal, the patients and their partners, lack sufficient up-to-date information to help us in this decision that is so clinically relevant. The BAP guidelines25 indicate that the fact of being a woman of Clindamycin Topical (Cleocin T)- Multum potential does not seem to influence the prescription of valproic acid.

With respect to the use of valproic post critical in pregnant women Clindamycin Topical (Cleocin T)- Multum those of childbearing potential for acute mania treatment, the guidelines indicate the recent warnings against its use and Clindamycin Topical (Cleocin T)- Multum need for informed consent from the patient, providing the web address at which more information can be obtained.

For long-term treatment in monotherapy, their recommendation is that, with Level I evidence (maximum), valproic acid generally should not be considered for women of childbearing potential. However, when drug combinations are mentioned, there is no warning about the use of valproic acid.

If, for clinically-justified reasons recorded in the patient's medical history, treatment with valproic acid is started, the following measures should be taken and recorded in the patient history:a. Tell the patient and her partner (if applicable) of the risks of congenital malformations and cognitive and behavioural sex risk pregnancy that are involved with this drug.

Make sure that she or they have understood the risks explained. Obtain written informed consent before prescribing the drug. Tell the patient about the need to notify her psychiatrist if she wants to get pregnant for proper pregnancy planning at the most appropriate time. Tell Clindamycin Topical (Cleocin T)- Multum about the need to let her psychiatrist know she is pregnant as soon as she finds out that this has happened.

Notify the AEMPS of any adverse effects that appear in offspring, regardless of whether they are effects associated with or attributable to prenatal exposure to valproic acid.

In the case of pregnant women or women of childbearing potential who are currently receiving valproic acid for their bipolar disorder, in whom other drugs have not been tried, the steps below should be followed:(1)Tell the patient and her partner (if applicable) Clindamycin Topical (Cleocin T)- Multum the risks of congenital malformations and cognitive and behavioural teratogenicity involved with this drug. With the patient and her partner (if applicable), discuss the possibility of using another drug to replace valproic acid, klipal codeine for treatment of acute mania and for long-term treatment.

If the shared decision is to continue with valproic acid treatment, the indications (2) c-g of the previous case (commencement of treatment) Clindamycin Topical (Cleocin T)- Multum be implemented. These procedures will be applied as soon as possible (preferably in the following visit), unless this is contraindicated by the patient's clinical state, in which case the process of shared decision-making should be postponed until the clinically appropriate time.

All the recommendations implemented must be recorded in the Clindamycin Topical (Cleocin T)- Multum case history. In the case of pregnant women or those of childbearing potential currently in treatment with valproic acid for their bipolar disorder, for whom the other pharmacological options were not effective or were not tolerated, the indications (2) a-g of the first case above (commencement of treatment) should be adopted and recorded.

In conclusion, pending the new EMA report on the need or lack of Clindamycin Topical (Cleocin T)- Multum to increase the restrictions on the use of valproic acid in pregnant women or women of childbearing potential, Spanish psychiatrists should keep the important preventative measures recommended well in mind, considering the current state of knowledge.

Rev Psiquiatr Salud Ment (Barc. PRAC recommends strengthening the restrictions on the use of valproate in women and girls. Women to be better informed of the risks of valproate use during pregnancy.

Bioethical procedure for decision-making in mental health. Rev Psiquiatr Salud Ment (Barc), 9 (2016), pp. New review of valproate use in pregnancy and women of childbearing age. EMA to consider if risks of these medicines require further restrictions of use.

Guideline adherence for mentally ill reproductive-aged women on treatment with valproic acid: a retrospective chart review.

J Clin Psychiatry, 77 (2016), pp. Prescribing trends for sodium valproate in Ireland. Seizure, no micro forte (2016), pp.

Pregnancy outcomes in women with epilepsy: a systematic review and meta-analysis of published pregnancy registries and cohorts. Epilepsy Res, 81 (2008), pp. Early cognitive development in children born to women with epilepsy: a prospective report. Epilepsia, 51 (2010), pp. Epilepsy Behav, 22 (2011), pp. Language skills of school-aged children prenatally exposed to antiepileptic drugs. Neurology, 76 (2011), pp. The Australian brain and cognition and antiepileptic drugs study: IQ in school-age children exposed to sodium valproate and polytherapy.

J Int Neuropsychol Soc, 17 (2011), pp. Prenatal valproate exposure and risk of autism spectrum disorders and childhood autism. JAMA, 309 (2013), pp.

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