What are the potential effects on a pregnant patient after accidentally taking a single dose of Depakote (valproate) 500mg and Abilify (aripandel) 5mg?

From the Guidelines

If a pregnant patient accidentally took a single dose of Depakote 500 mg (valproic acid) and Abilify 5 mg (aripipanzole), she should contact her healthcare provider or go to an emergency department immediately. Depakote is particularly concerning during pregnancy as it carries a significant risk of birth defects and developmental delays, especially during the first trimester, as noted in the study published in the American Family Physician in 2013 1. It is classified as FDA Pregnancy Category X, meaning the risks clearly outweigh any potential benefits in pregnancy. This classification is due to its teratogenic effects, which include an increased risk of congenital anomalies, especially when used in higher doses or as part of polytherapy for seizure disorders 1. Abilify poses fewer known risks but still requires evaluation.

Key Considerations

• The patient's healthcare provider will need to assess several factors including how far along the pregnancy is, the patient's medical history, and whether she needs these medications for an underlying condition.
• They may recommend monitoring through additional ultrasounds or other prenatal testing to check fetal development, as the risk of congenital anomalies is a concern with valproate use 1.
• While a single accidental dose may have limited impact compared to ongoing use, prompt medical consultation is essential to properly evaluate the situation and determine appropriate next steps.
• The healthcare provider can also discuss safer alternative medications if treatment for a psychiatric condition is needed during pregnancy, considering the potential for harm to the fetus with certain medications, such as valproate, which is contraindicated in pregnancy due to its teratogenic effects 1.

Recommendations for Management

• Prompt evaluation by a healthcare provider is crucial to assess the risk and determine the best course of action.
• Monitoring for fetal development and potential congenital anomalies should be considered, given the known risks associated with valproate.
• Discussion of alternative treatments for any underlying psychiatric conditions should prioritize medications with a safer profile during pregnancy.
• The patient should be educated on the potential risks and the importance of close monitoring throughout the pregnancy.

From the FDA Drug Label

THE STRONGEST ASSOCIATION OF MATERNAL VALPROATE USAGE WITH CONGENITAL MALFORMATIONS IS WITH NEURAL TUBE DEFECTS THE INCIDENCE OF NEURAL TUBE DEFECTS IN THE FETUS IS INCREASED IN MOTHERS RECEIVING VALPROATE DURING THE FIRST TRIMESTER OF PREGNANCY. Evidence suggests that pregnant women who receive folic acid supplementation may be at decreased risk for congenital neural tube defects in their offspring compared to pregnant women not receiving folic acid Other Adverse Pregnancy Effects PATIENTS TAKING VALPROATE MAY DEVELOP CLOTTING ABNORMALITIES FATAL HEPATIC FAILURES, IN A NEWBORN AND IN AN INFANT, HAVE BEEN REPORTED FOLLOWING THE MATERNAL USE OF VALPROATE DURING PREGNANCY.

The potential effects on a pregnant patient after accidentally taking a single dose of Depakote (valproate) 500mg include:

• Increased risk of neural tube defects in the fetus
• Clotting abnormalities
• Hepatic failure in the newborn or infant It is recommended that folic acid supplementation be taken to potentially decrease the risk of congenital neural tube defects. 2

From the Research

Potential Effects of Depakote (Valproate) and Abilify (Aripandel) on a Pregnant Patient

• The potential effects of a single dose of Depakote (valproate) 500mg on a pregnant patient are related to the drug's teratogenic properties, which may increase the risk of neural tube defects (NTDs) and other congenital abnormalities 3, 4, 5, 6.
• Valproate has been shown to interfere with one-carbon metabolism, including the transport of methylfolate into the brain and the placenta, which may contribute to congenital and developmental problems 3.
• Folic acid supplementation has been proposed as a potential protective measure against valproate-induced NTDs, but the standard periconceptual dose of 400 μg may not be sufficient, and higher doses (up to 5 mg) may be recommended for at-risk women 3, 4, 7.
• The effect of a single dose of Abilify (aripandel) 5mg on a pregnant patient is not directly addressed in the provided studies, but it is essential to consider the potential risks and benefits of any medication during pregnancy.
• Women taking valproate or other antiepileptic drugs during pregnancy should be closely monitored, and folic acid supplementation should be considered to reduce the risk of NTDs and other congenital abnormalities 5, 7.

Folic Acid Supplementation

• Folic acid supplementation has been shown to reduce the risk of spontaneous spina bifida, but its effectiveness in reducing the risk of valproate-induced NTDs is still being studied 4, 5, 7.
• The recommended dose of folic acid for women taking valproate or other antiepileptic drugs during pregnancy is higher than the standard periconceptual dose, ranging from 4.0 mg to 5.0 mg daily 7.
• Folic acid supplementation should be taken under medical supervision, and the risk of undiagnosed vitamin B12 deficiency should be minimized before initiating high-dose folic acid supplementation 7.