The NatPSA which was issued on 28 November 2023 by the MHRA states that, from 31 January 2024: • Valproate must not be started in new patients (male or female) younger than 55 years, unless two specialists independently agree and document that there is no other effective and tolerated treatment. • At their next annual specialist review, female patients of childbearing potential and girls should be reviewed using the latest valproate Acknowledgement of Risk Form, which will include the need for a second signatory if the patient is to continue with valproate.