Valproate: what the dispensing team checks before handout

Why this matters

Valproate can cause serious harm to a baby if taken during pregnancy, and there is evidence of risks linked to use by men in the months before conception. Because of this, valproate medicines carry some of the strictest safety measures of any medicine dispensed in a pharmacy. Several of those measures happen at the dispensing bench and the handout point, which is where technicians and dispensers come in.

What the dispensing team needs to know

• Valproate is dispensed in the manufacturer's original full pack. Since 11 October 2023 in England, Scotland and Wales, packs must not be split. If the quantity prescribed does not match a pack, the supply is rounded up or down to whole packs so the patient gets as close as possible to what was prescribed.
• The original pack matters because it carries the warning on the box, the patient information leaflet, a detachable patient card and a booklet about the risks in pregnancy. Every supply must include these.
• The only exception is where a documented risk assessment shows the medicine has to be repackaged, for example into a monitored dosage system, and the leaflet is still provided.
• Since 31 January 2024 valproate must not be started in any new patient under 55, male or female, unless two specialists have independently agreed there is no other effective or tolerated treatment. Women and girls who could become pregnant have an annual specialist review with a risk acknowledgement form.
• The pharmacist speaks to the patient, or their carer, at each supply about the risks and checks they have the patient card and the information. This is not something the dispensing team does on the pharmacist's behalf, but the team makes sure it happens.

At the bench and the handout point

1. Check the quantity against whole packs and query with the pharmacist if it does not fit.
2. Never split a valproate pack. If you see a split pack on the shelf, tell the pharmacist.
3. Check that the warning, leaflet, card and booklet are in the pack. If a pack has been opened or the card is missing, do not use it.
4. Flag the item to the pharmacist before handout so the conversation happens. Many pharmacies use a shelf sticker or a bag tag for this.
5. Record what was done if your SOP requires it. Some pharmacies keep a valproate log.

Refer to the pharmacist

• A prescribed quantity that does not fit whole packs
• A request to put valproate into a compliance aid
• A patient or carer who says they have not been told about the risks, or who asks about pregnancy, contraception or trying for a baby
• A new prescription for a patient under 55 who has not had valproate before
• A patient who says they want to stop taking it. Nobody should stop valproate without advice

PPets learning connection

Medicines with special dispensing requirements and safety alerts are covered in the Level 3 Diploma. This briefing is a useful worked example for a professional discussion.

Record this as CPD

Registered pharmacy technicians can use this article towards GPhC revalidation, as an unplanned CPD entry or as the starting point for a reflective account. Pharmacy assistants and trainees can use it as evidence of reflective practice. Note down three things:

1. What you learned from this article
2. How you have applied it, or will apply it, in your own role
3. The benefit to the people who use your pharmacy's services

Sources and further reading

• GOV.UK: full pack dispensing of valproate-containing medicines
• GOV.UK: new valproate safety measures apply from 31 January 2024
• GOV.UK: valproate safety measures collection

Related from PPets

• Level 3 Diploma for pharmacy technicians
• Free resources

This article is for general educational purposes only. It is not legal advice, professional regulatory advice or clinical advice about an individual patient. Always follow your pharmacy's SOPs and check current official guidance and product information.

← Back to the CPD Portal