A 29-year-old, 4 months pregnant primigravida has history of juvenile myoclonic epilepsy. She has been regularly taking sodium valproate and now presents requesting for an opinion for a change in her anti-epileptic treatment. What would you sugeets her?
Immediately taper off valproate and sta lamotrigine
Switch to carbamazepine
Continue valproate and serial drug monitoring in blood
Add lamotrigine to valproate
Answer: c. Continue valproate and serial drug monitoring in blood (Ref Harrison I9/e p2544, 18/e p3269)Continue valproate with serial drug monitoring in the blood of the 4-month old patient having history of juvenile myoclonic epilepsy.