Valproic acid dosing, indications, interactions, adverse effects, and more (2023)

Patient Education
valproic acid oral

VALPROIC ACID - ORAL

(val-PROE-ik As-id)

(Video) Valproic acid || Mechanism, side effects and indications

COMMON BRAND NAME(S): Depakene

WARNING: Rarely, this medication has caused serious (sometimes fatal) liver problems, usually within the first 6 months of starting treatment. Laboratory tests should be performed before you start treatment and periodically during treatment, especially within the first 6 months, to monitor this side effect.The risk of serious liver problems is increased in children younger than 2 years, especially if they have an inherited metabolic disorder, severe seizure disorder with mental retardation, organic brain disease, or if they take more than one seizure medication. Talk with the doctor about the risks and benefits of using this medication in children younger than 2 years.Due to an increased risk for liver problems, people with certain inherited metabolic disorders (such as Alpers-Huttenlocher syndrome) should not use this medication. Children younger than 2 years who might have these disorders should not use this medication. Children older than 2 years who might have these disorders should be closely monitored during treatment with valproic acid. Talk to your doctor for details.This medication has rarely caused severe (sometimes fatal) disease of the pancreas (pancreatitis). This may occur at any time during treatment and can quickly worsen.Tell your doctor right away if you develop symptoms of liver problems or pancreatitis such as nausea/vomiting that doesn't stop, unusual tiredness, weakness, swelling of the face, stomach/abdominal pain, loss of appetite, dark urine, or yellowing eyes/skin.Taking this medication during pregnancy can cause birth defects, may lower your child's IQ, and may increase the risk of your child having certain brain/mental disorders (such as autism, attention deficit/hyperactivity disorder). Women of childbearing age should discuss the risks and benefits of this medication, other treatment options, and use of reliable forms of birth control with their doctor. If you are planning pregnancy, become pregnant, or think you may be pregnant, immediately talk to your doctor. If you are taking valproic acid only to prevent migraine headaches, this medication must not be used during pregnancy. If you are taking valproic acid to treat seizures or mental/mood problems (such as bipolar disorder), do not stop taking this medication unless directed by your doctor. Untreated seizures and mental/mood problems (such as bipolar disorder) are serious conditions that can harm both a pregnant woman and her unborn baby.

USES: This medication is used to treat seizure disorders, mental/mood conditions (such as manic phase of bipolar disorder), and to prevent migraine headaches. It works by restoring the balance of certain natural substances (neurotransmitters) in the brain.

(Video) Valproic Acid pharmacology : Uses, Side Effects, Interactions : Dr Rajesh gubba

HOW TO USE: Read the Medication Guide and, if available, the Patient Information Leaflet provided by your pharmacist before you start taking valproic acid and each time you get a refill. If you have any questions, ask your doctor or pharmacist.Take this medication by mouth as directed by your doctor. You may take it with food if stomach upset occurs. Swallow the capsule whole. Do not crush or chew the capsule, which can irritate the mouth or throat.The dosage is based on your age, weight, medical condition, response to treatment, and other medications you may be taking. Be sure to tell your doctor and pharmacist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products). Use this medication regularly in order to get the most benefit from it. Remember to use it at the same time each day to keep the amount of medication in your blood constant.If this medication is used for seizures, do not stop taking it without consulting your doctor. Your condition may become worse if the drug is suddenly stopped. Your dose may need to be gradually decreased.This medication does not relieve acute migraine headaches. Take other medications as directed by your doctor for acute attacks.Inform your doctor if your condition does not improve.

SIDE EFFECTS: See also Warning section.Diarrhea, dizziness, drowsiness, hair loss, blurred/double vision, change in menstrual periods, ringing in the ears, shakiness (tremor), unsteadiness, weight changes may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Parts of a capsule may appear in your stool. Tell your doctor right away if this occurs.A small number of people who take anticonvulsants for any condition (such as seizure, bipolar disorder, pain) may experience depression, suicidal thoughts/attempts, or other mental/mood problems. Tell your doctor right away if you or your family/caregiver notice any unusual/sudden changes in your mood, thoughts, or behavior including signs of depression, suicidal thoughts/attempts, thoughts about harming yourself.Severe (sometimes fatal) brain disorder (encephalopathy) has rarely occurred, particularly in patients with certain metabolic disorders (urea cycle disorders). Tell your doctor right away if you develop unexplained weakness, vomiting, or sudden mental/mood changes (such as confusion).Get medical help right away if you have any very serious side effects, including: chest pain, easy bruising/unexplained bleeding, fast/slow/irregular heartbeat, swelling of hands/feet, uncontrolled eye movement (nystagmus), feeling cold/shivering, rapid breathing, loss of consciousness.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: fever, swollen lymph nodes, rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

PRECAUTIONS: See also Warning section.Before taking valproic acid, tell your doctor or pharmacist if you are allergic to it; or to divalproex or valproate sodium; or if you have any other allergies. This product may contain inactive ingredients (such as peanut oil), which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: liver disease, pancreatitis, certain metabolic disorders (such as urea cycle disorders, Alpers-Huttenlocher syndrome), alcohol abuse, bleeding problems, brain disease (dementia), kidney disease, dehydration, poor nutrition.To lower the chance of getting cut, bruised, or injured, use caution with sharp objects like razors and nail cutters, and avoid activities such as contact sports.Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).This drug may make you dizzy or drowsy or blur your vision. Alcohol or marijuana (cannabis) can make you more dizzy or drowsy. Do not drive, use machinery, or do anything that needs alertness or clear vision until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).Children younger than 6 years may be at greater risk for liver problems and pancreatitis.Older adults may be more sensitive to the side effects of this drug, especially drowsiness, dizziness, unsteadiness, or tremor. Drowsiness, dizziness, unsteadiness can increase the risk of falling.Tell your doctor if you are pregnant or plan to become pregnant. You should not become pregnant while using valproic acid. Valproic acid may harm an unborn baby. If you become pregnant, talk to your doctor right away about the risks and benefits of this medication. See also Warning section.This medication passes into breast milk. While there have been no reports of harm to nursing infants, consult your doctor before breast-feeding.

(Video) How to Remember Side Effects of Valproate/ Valproic Acid in 4 Minutes??

DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug include: certain antidepressants (such as amitriptyline, nortriptyline, phenelzine), certain antibiotics (carbapenems such as imipenem), irinotecan, mefloquine, orlistat, other medications for seizure (such as ethosuximide, lamotrigine, rufinamide, topiramate), rifampin, vorinostat, warfarin, zidovudine.Low-dose aspirin, as prescribed by your doctor for specific medical reasons such as heart attack or stroke prevention (usually 81-162 milligrams a day), should be continued. Consult your doctor or pharmacist if you are using aspirin for any reason.Tell your doctor or pharmacist if you are taking other products that cause drowsiness including alcohol, marijuana (cannabis), antihistamines (such as cetirizine, diphenhydramine), drugs for sleep or anxiety (such as alprazolam, zolpidem), muscle relaxants (such as carisoprodol, cyclobenzaprine), and opioid pain relievers (such as codeine, hydrocodone).Check the labels on all your medicines (such as allergy or cough-and-cold products) because they may contain ingredients that cause drowsiness. Ask your pharmacist about using those products safely.This drug may affect certain lab tests (such as urine ketones). Make sure laboratory personnel and your doctors know you use this medication.

OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: excessive drowsiness, coma, irregular/slow heartbeat.

NOTES: Do not share this medication with others.Laboratory and/or medical tests (such as drug levels, liver function tests, complete blood counts, clotting tests) should be performed before you start treatment, periodically to monitor your progress, or to check for side effects. Consult your doctor for more details.

(Video) Valproic Acid (Valproate) Mnemonic for Nursing Pharmacology (NCLEX)

MISSED DOSE: If you miss a dose, use it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Use your next dose at the regular time. Do not double the dose to catch up.

STORAGE: Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

MEDICAL ALERT: Your condition can cause complications in a medical emergency. For information about enrolling in MedicAlert, call 1-888-633-4298 (US) or 1-800-668-1507 (Canada).

(Video) Depakote / Depakene (Valproic Acid) Can Have Life-Changing Side Effects

Information last revised March 2022. Copyright(c) 2022 First Databank, Inc.

IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

FAQs

What is the indication for valproic acid? ›

Valproic acid is used to treat bipolar disorder. It's occasionally used to prevent migraine and can also be used to treat epilepsy. This medicine is only available on prescription. It comes as capsules or tablets.

What medications interact with valproic acid? ›

Some products that may interact with this drug include: certain antidepressants (such as amitriptyline, nortriptyline, phenelzine), certain antibiotics (carbapenems such as imipenem), irinotecan, mefloquine, orlistat, other medications for seizure (such as ethosuximide, lamotrigine, rufinamide, topiramate), rifampin, ...

What adverse effect is commonly associated with valproic acid? ›

Valproic acid may cause serious allergic reactions affecting multiple body organs (eg, liver or kidney). Check with your doctor right away if you have the following symptoms: a fever, dark urine, headache, rash, stomach pain, swollen lymph glands in the neck, armpit, or groin, unusual tiredness, or yellow eyes or skin.

What should be monitored while taking valproic acid? ›

Obtain baseline complete blood cell counts with differential (CBC with diff); liver function tests, and pregnancy test for females. Monitor Depakote levels, liver function tests, and CBC with diff every 3-6 months. Monitor for development of polycystic ovary disease in females.

When should you not take valproic acid? ›

You should not use valproic acid if you are allergic to it, or if you have: liver disease; a urea cycle disorder; or. a genetic mitochondrial (MYE-toe-KON-dree-al) disorder such as Alpers' disease or Alpers-Huttenlocher syndrome, especially in a child younger than 2 years old.

What is the difference between valproate and valproic acid? ›

Divalproex sodium (Depakote), sodium valproate, and valproic acid are often confused. Valproic acid is the protonated form — in case that term doesn't bring back memories from biochemistry, that means that the compound is bonded to a proton (H+). Sodium valproate, on the other hand, is the sodium salt of valproic acid.

Does caffeine interact with valproic acid? ›

A synergistic interaction between caffeine and valproic acid was observed for 143B and MG63 cells (Figure 1). The CI values were significantly <1 and indicated synergy at all tested concentrations in the MG63 cell line (Table II). In the 143B cell line, synergy was observed at caffeine concentration of 1 mM or higher.

Why is valproic acid a hazardous drug? ›

Valproic acid can cause serious birth defects (physical problems that are present at birth), especially affecting the brain and spinal cord and can also cause lower intelligence and problems with movement and coordination, learning, communication, emotions, and behavior in babies exposed to valproic acid before birth.

Can you take paracetamol with valproic acid? ›

No interactions were found between Paracetamol and valproic acid. However, this does not necessarily mean no interactions exist. Always consult your healthcare provider.

Do you need to monitor valproate levels? ›

The need for therapeutic drug monitoring of valproate in the treatment of epilepsy has been demonstrated. A plasma trough concentration exceeding 50 mg/L is advised in order to reach therapeutic effects on epilepsy, and trough levels exceeding 100-120 mg/L are associated with toxicity and occurrence of adverse events.

Does valproic acid require blood monitoring? ›

A valproic acid level measures the amount of valproic acid in the blood: either the total level or free level of the drug. Monitoring of serial valproic acid levels is required to maintain the drug within the narrow recommended therapeutic range.

Can you drink alcohol while taking valproic acid? ›

valproic acid food

Alcohol can increase the nervous system side effects of valproic acid such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with valproic acid.

Does valproic acid affect sleep? ›

Furthermore, other studies have indicated that epileptic patients who had been administered VPA presented with sleep problems, including daytime drowsiness, fatigue, difficulty concentrating, seizure worsening and circadian rhythm disorder (3).

What drugs should not be taken with sodium valproate? ›

Some products that may interact with this drug include: certain antidepressants (such as amitriptyline, nortriptyline, phenelzine), certain antibiotics (carbapenems such as imipenem), irinotecan, mefloquine, orlistat, other medications for seizure (such as ethosuximide, lamotrigine, rufinamide, topiramate), rifampin, ...

Is valproate a sedating? ›

Common adverse effects of valproate include nausea, upper abdominal cramps, abnormal liver function, weight gain and diarrhoea. Neurological adverse effects such as tremor, fatigue, sedation, confusion and dizziness are often observed.

What happens if your valproic acid is too low? ›

The valproic acid level in the blood must be maintained within a narrow therapeutic range. If the level is too low, someone may experience a recurrence of symptoms, but, if the level is too high, someone may experience an increase in the number and severity of symptoms and side effects.

Does ibuprofen interact with valproic acid? ›

To our knowledge, no interaction between ibuprofen and valproic acid has been reported.

Can you drink milk with Depakote? ›

Avoid milk, milk products, iron- containing products, or antacids containing calcium, magnesium, and aluminum one hour before or 2 hours after taking these medications. Take on an empty stomach with a full glass of water. Avoid alcohol.

Can valproate help with anxiety? ›

The first and only double-blind, placebo-controlled randomized study that investigated the effectiveness of valproate in the treatment of anxiety disorders in 68 patients with generalized anxiety disorder reported that valproate significantly reduced anxiety symptoms compared to placebo [8.

Does valproate have a black box warning? ›

Overview. Valproate sodium is an anticonvulsant that is FDA approved for the treatment of epilepsy. There is a Black Box Warning for this drug as shown here. Common adverse reactions include injection site pain, injection site reaction, nausea, dizziness, headache, and somnolence.

What does valproate do to the brain? ›

Sodium valproate prevents epileptic fits by stabilising excessive electrical activity in the brain. It is thought to achieve this in two ways: by increasing the activity of a natural 'nerve-calming' agent called GABA in the brain, and by preventing electrical signals from building up in nerve cells in the brain.

Can you take omeprazole with sodium valproate? ›

Interactions between your drugs

No interactions were found between omeprazole and Valproate Sodium. However, this does not necessarily mean no interactions exist. Always consult your healthcare provider.

Is sodium valproate a high risk drug? ›

Sodium valproate and valproic acid are known collectively as valproate. Brands include Epilim, Depakote, Convulex, Episenta, Epival, Kentlim, Orlept, Syonell and Valpaland.

What happens to valproic acid when aspirin taken together? ›

Additionally, aspirin is known to increase the concentration of valproic acid, which could potentially lead to toxicity and increased side effects. To manage this, it is recommended to reduce to the dose of valproic acid.

What is valproic acid IV used for? ›

Descriptions. Valproate sodium injection is used to treat certain types of seizures (epilepsy). This medicine is an anticonvulsant that works in the brain tissue to stop seizures.

What type of seizure is valproic acid used for? ›

Valproic acid can be effective against many types of seizures common in children: absence seizures (this is one of the most effective medicines for these brief staring spells) myoclonic seizures. tonic-clonic seizures, such as those in Lennox-Gastaut syndrome.

What symptoms does valproate treat? ›

Valproate is a mood stabilizer medication that works in the brain. It is approved for the treatment of mania associated with bipolar disorder (also known as manic depression), seizures (epilepsy), and migraine headaches. Bipolar disorder involves episodes of depression and/or mania.

What class of medication is valproic acid? ›

Valproic acid is used to treat certain types of seizures (epilepsy). This medicine is an anticonvulsant that works in the brain tissue to stop seizures.

Why is valproic acid a hazardous drug? ›

Valproic acid can cause serious birth defects (physical problems that are present at birth), especially affecting the brain and spinal cord and can also cause lower intelligence and problems with movement and coordination, learning, communication, emotions, and behavior in babies exposed to valproic acid before birth.

What drugs should not be taken with sodium valproate? ›

Some products that may interact with this drug include: certain antidepressants (such as amitriptyline, nortriptyline, phenelzine), certain antibiotics (carbapenems such as imipenem), irinotecan, mefloquine, orlistat, other medications for seizure (such as ethosuximide, lamotrigine, rufinamide, topiramate), rifampin, ...

Does valproate require blood monitoring? ›

Valproate-induced cytopenias may be dose-related and warrant monitoring of complete blood counts during therapy.

Does valproic acid affect memory? ›

Valproic acid (VPA), an agent that is used to treat epileptic seizures, can cause spatial memory impairment in adults and children. This effect is thought to be due to the ability of VPA to inhibit neurogenesis in the hippocampus, which is required for learning.

Can sodium valproate make seizures worse? ›

Valproate sodium interferes with the glycine cleavage enzyme synthesis in the mitochondria, hence increasing glycine levels. The increased glycine levels are responsible for worsening of the underlying metabolic condition and increased seizure frequency.

Why do epileptics take folic acid? ›

Most experts agree that folic acid supplementation is a key preconception intervention, particularly in women with epilepsy who take anti-epileptic drugs (AEDs). Primary prevention of neural tube defect through folic acid supplementation results in reduction of risk in an otherwise healthy population.

Does valproate help with sleep? ›

Low-dose valproic acid appears to be one of the effective means of entraining circadian rhythms in patients with non-24-hour sleep–wake syndrome, which in turn likely improves associated depressive symptoms.

Is valproate a sedating? ›

Common adverse effects of valproate include nausea, upper abdominal cramps, abnormal liver function, weight gain and diarrhoea. Neurological adverse effects such as tremor, fatigue, sedation, confusion and dizziness are often observed.

Does valproate cause confusion? ›

Valproate-related hyperammonaemic encephalopathy is a treatable condition which should be considered as a diagnosis in anyone taking sodium valproate with new onset confusion, even in the presence of therapeutic sodium valproate levels and normal liver function tests.

Does valproic acid affect sleep? ›

Furthermore, other studies have indicated that epileptic patients who had been administered VPA presented with sleep problems, including daytime drowsiness, fatigue, difficulty concentrating, seizure worsening and circadian rhythm disorder (3).

Is valproic acid an antipsychotic? ›

Valproic Acid (VPA) as a Benzodiazepine- and Antipsychotic-Sparing Treatment for Agitation Associated with Hyperactive Delirium (SCI935) - Journal of Pain and Symptom Management.

Is valproic acid an antidepressant? ›

Valproic acid, beside its anticonvulsant action, is widely used as a mood stabilizer in the therapy of bipolar disorder. The potential antidepressant action of valproic acid has not been sufficiently characterized so far.

Videos

1. How to use Valproic Acid? (Depakine, Valproate Sodium) - Doctor Explains
(HOW TO MEDICATE)
2. Valproic Acid: History, Treatment in Bipolar, Schizophrenia, and Aggression with Dr. Cummings
(Psychiatry & Psychotherapy)
3. Valproate/Divalproex: Metabolism, Kinetics, and Warnings
(Psychopharmacology Institute)
4. Valproic Acid Derivatives for Seizures, Bipolar Disorder, and Migraine Headaches
(Drugs in Motion)
5. Valproic Acid, Lamotrigine, and Topiramate - All Antiepileptic Medications (Seizure Treatments)
(USMLE pass)
6. Brandl's Basics: Antiseizure medications (3/3): Adverse effects
(Katharina Brandl)
Top Articles
Latest Posts
Article information

Author: Terence Hammes MD

Last Updated: 01/13/2023

Views: 5926

Rating: 4.9 / 5 (69 voted)

Reviews: 84% of readers found this page helpful

Author information

Name: Terence Hammes MD

Birthday: 1992-04-11

Address: Suite 408 9446 Mercy Mews, West Roxie, CT 04904

Phone: +50312511349175

Job: Product Consulting Liaison

Hobby: Jogging, Motor sports, Nordic skating, Jigsaw puzzles, Bird watching, Nordic skating, Sculpting

Introduction: My name is Terence Hammes MD, I am a inexpensive, energetic, jolly, faithful, cheerful, proud, rich person who loves writing and wants to share my knowledge and understanding with you.