Valproic acid
Commercial names and formulations:
Brand names: Depakene, Depakote, Depakote ER, Depakote Sprinkle
Formulations: tablet, capsules, oral solution, injectable solution
Years on the market:
In the US since 1978
How to store it?
Store at room temperature
What does the body do to the medication?
Can I take it with food?
Yes
How long does it take to get to the blood after I take it?
2-4 hours
How long does it take to start having a steady effect?
2-5 days
Can this medication be started at a high dose or it has to be started gradually?
Gradually or rapidly if given by vein
How long does it stay in the body?
About one quarter to one half day
How is it eliminated?
Liver
What does the medication do to the body?
Type of epilepsy that helps:
Partial and Generalized Epilepsy, multiple seizure types
FDA approved for:
Complex partial seizures (alone or in combination with other medications), absence seizures
Common side effects:
• Skin: hair loss, skin discoloration
• Bones: none
• Blood: low platelet count
• Liver: none
• Kidneys: none
• Stomach and intestines: nausea, diarrhea, vomiting, abdominal pain, weight loss, upset stomach, constipation
• Heart: none
• Brain: tremor, drowsiness, dizziness, insomnia, nervousness, amnesia, uncontrolled eye movements
• Mood: depression
• Others: loss of strength/weakness, ringing in the ears
Serious side effects:
Liver problems and/or failure
Neural tube defects (such as spina bifida)
Serious inflammation of the pancreas
Risk of suicidal thoughts or behavior
Polycystic Ovary Syndrome
What happens if I get too much of it (intoxication)?
Symptoms may include drowsiness, heart failure, and deep coma.
What happens if I stop it suddenly (withdrawal)?
This medication should not be stopped suddenly. Abruptly stopping treatment with valproic acid may cause an increase in seizures or status epilepticus.
Who should not take this medication?
You should not take it if you have liver disease or serious liver problems, or if you are allergic to any of the ingredients of valproic acid or valproate.
What is the average dose and how many times a day should be given?
Initial 10-15 mg/kg/day (increase by 5-10 mg/kg/week to final dose below 60 mg/kg/day). Given 2-3 times per day, once per day for extended release
Does the body get used to the medication?
Yes
Medications to be careful with:
Other AEDs that can increase the blood levels of Valproic Acid:
Felbamate
Other AEDs that can decrease the blood levels of Valproic Acid:
Phenobarbital, Phenytoin, Primidone, Ethosuximide, Carbamazpine, Topamax
Other drug interactions:
Increases levels of lorazepam and zidovudine. Increases levels of amitriptyline and nortriptyline. Increases the levels of lamotrigine, phenytoin, Phenobarbital, mysoline, carbamazepine
Blood work required?
CBC and CPM?
Yes
How often?
1-3 months at first then less often
Are medication levels in blood useful?
Yes
Normal range
50-100
Women’s health
Affects contraceptives?
No
Affect fertility?
Yes
Are safe in pregnancy?
The highest risk of birth defects of all seizure medication. Discuss this with your doctor.
Category
Pregnancy Category D
Can breastfeed?
The medication will be present in breastmilk and its effects on the nursing infant are unknown
Affect bones (osteoporosis)?
Unknown
Men’s health
Affects sexual performance?
No
Affects fertility?
Unknown
Use other than epilepsy:
Bipolar Disorder, Migraine