Which medication would warrant urgent GP review due to teratogenic risk in a patient who plans to conceive?

• A. Sodium valproate
• B. Lamotrigine
• C. Paracetamol
• D. Levetiracetam

Answer: (C)

Before conception, medicines with known teratogenic risk should be reviewed to protect the fetus. The drug with the strongest evidence of causing fetal malformations is valproate, which is linked to neural tube defects and other congenital anomalies, as well as potential neurodevelopmental issues. Because of this, urgent GP review is warranted to discontinue or switch to a safer alternative before pregnancy, with careful monitoring and appropriate planning (such as folic acid supplementation and timing of the switch) under specialist guidance. Paracetamol, at standard doses, does not carry a major teratogenic risk and is generally considered safe in pregnancy, so it would not require urgent change solely for teratogenic concerns. Alternatives like lamotrigine or levetiracetam have lower risks compared with valproate and may be discussed as options depending on the condition being treated and seizure control.