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	The Pharmaceutical Journal Vol 269 No 7224 p711 16 November 2002	This page Reprint Photocopy
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BNF

Indexing valproic acid salts clearly

From Ms L. Durke, MRPharmS

Following on from my previous letter (PJ, 20 July, p97) regarding the indexing of valproate in the British National Formulary, I now reply to the question posed by Dinesh Mehta. The problems associated with the indexing of valproate in the BNF have been discussed by a group of pharmacists locally and the following outlines the problems raised.

The box and patient information leaflet for Depakote states that the product contains valproate semisodium. It is only when the text of the leaflet is read that it is mentioned that valproate semisodium is equivalent to valproic acid. The BNF does not mention valproate semisodium in the index. The reader is therefore directed to look under valproate. There are six entries under valproate in the current BNF, including bipolar disorder. At the start of the index, the BNF state that the principal reference page is printed in bold type. This leads readers to p238 — a page dedicated to epilepsy products. Although there is mention of valproic acid (as the semisodium) at the top of this page under the introduction to valproate, valproic acid is also an ingredient of some of the epilepsy products, for example Epilim Chrono.

Usually the diagnosis is not available to the dispensing pharmacist and, in hospital pharmacy especially, the brand name is generally not stated.

All salts, including the semisodium, should be mentioned in the index and use in psychiatry should also be highlighted as a principal reference page.

Lesley Durke
Senior Pharmacist,
Glan Clwyd Hospital

DINESH MEHTA, executive editor, British National Formulary, states:

We can understand Ms Durke's view that the BNF index entries might not inform the reader of a valproate product licensed for the management of bipolar disorder. Although the BNF index does mention valproate in bipolar disorder, we have nevertheless planned changes to further clarify availability of specific valproate products for bipolar disorder. I should also explain that the BNF uses "Valproic acid" as the monograph title in the section on antimanic drugs because the dose is stated in terms of valproic acid and not semisodium valproate.

We believe that the real issue is how valproate products should be prescribed unambiguously to ensure the correct one is supplied.

Depakote 250mg tablets contain 269.1mg of semisodium valproate; this is equivalent to 250mg of valproic acid. For good reasons, prescribers are encouraged to use approved names but it would be incorrect to prescribe the tablets as "semisodium valproate tablets 250mg" even though the manufacturer's description might suggest this. On the other hand, "semisodium valproate tablets 269.1mg", while correct, is unlikely to find favour with prescribers. Here, prescribing by brand name reduces the possibility of the wrong product being dispensed.

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