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Prescribing and monitoring of carbamazepine and valproate — a case note review

Chief Pharmacist, South London and Maudsley NHS Trust and Honorary Senior Lecturer, Institute of Psychiatry, De Crespigny Park, Denmark Hill, London SE5 8AF

Kate Starkey, Clinical Pharmacist

Hounslow & Spelthorne Community and Mental Health NHS Trust

Saira Ginary, Clinical Pharmacist

Camden & Islington Community Health Services NHS Trust, London

AIMS AND METHOD

To evaluate prescribing and monitoring of carbamazepine and valproate to patients in secondary care psychiatric units. Review of prescription cards and medical case notes.

RESULTS

Prescribing details for 433 patients were recorded. Both carbamazepine and valproate were widely prescribed for indications not listed in their product licences. Plasma level monitoring was not frequently undertaken, particularly with valproate. Where plasma levels were measured, apparently sub-therapeutic prescribing was found to be common. For the majority of samples, it could not be established that a true trough level had been taken. Monitoring of blood function was highly variable. Overall, the quality of both prescribing and monitoring was poor.

CLINICAL IMPLICATIONS

Patients may receive sub-therapeutic treatment or experience unnecessary adverse effects. Prescribing and monitoring need to be more evidence-based in line with the ideals of clinical governance.

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