Published: 13 December 2017

MARC’s Remarks: September 2017 Meeting

Prescriber Update 38(4): 55
December 2017

The Medicines Adverse Reactions Committee (MARC) met on 14 September 2017 to discuss a number of medicine-related safety issues.

The MARC discussed the use of sodium valproate (Epilim) in pregnancy. The MARC considered that there are women with epilepsy for whom sodium valproate is the only effective medicine. However, when considering the use of sodium valproate in bipolar disorder the MARC considered there are alternatives that can be used. The MARC considered that it would be appropriate to restrict the indication for use in bipolar disorder to when other treatments have failed. In women of childbearing potential effective contraception must also be prescribed.

The MARC noted that the Accident Compensation Corporation (ACC) together with the Ministry of Health, the Health Quality & Safety Commission and Foetal Anti-Convulsant Syndrome New Zealand (FACS NZ) have worked with 15 clinicians and consumer advocates to create and distribute booklets on the benefits and risks of taking antiepileptic medicines for females. These booklets are available online and copies can be ordered for free on ACC’s website (

The MARC discussed the use of immune checkpoint inhibitors in the New Zealand context. The MARC considered it important that knowledge about immune-mediated adverse effects with these medicines was widely disseminated to healthcare professionals likely to be involved in the care of these patients. Further information on these medicines is available in this edition of Prescriber Update1.

The MARC discussed the risks of severe depression, anxiety and suicidal ideation with hormonal contraceptives. The MARC noted that there have been reports of altered mood with the use of hormonal contraceptives. However, the available information on the risks of severe depression, anxiety and suicidal ideation with the use of hormonal contraceptives is conflicting. It is important for patients presenting with these symptoms to be referred to mental health service providers for support and an alternative method of contraception to be provided if necessary.

Further information on this meeting can be found on the Medsafe website ( Papers presented to the MARC are also published on the Medsafe website (

  1. 2017. Spotlight on New Anti-Cancer Therapy — Immune Checkpoint Inhibitors. Prescriber Update 38(4): 50.