Valproic Acid (Depakote) for Seizure disorders

  • Type of Drug: Anticonvulsant; antimanic.
  • Prescribed for: Seizure disorders, including petit mal, absence, grand mal, and myoclonic. Valproic Acid is also prescribed for manic-depressive illness, prevention of fever convulsions fin children), and mild urinary incontinence.
  • Brand Name: Depakene Capsules/Syrup, Depakote Tablets/Sprinkle Capsules.

Cautions and Warnings of Valproic Acid

The information contained in this profile applies to both forms of the drug: Valproic Acid (Depakene) and Divalproex Sodium (Depakote). Divalproex is made up of equal quantities of Valproic Acid and Sodium Valproate. The dosage of Divalproex is measured in terms of the equivalent dosage of Valproic Acid. Valproic Acid is chemically unrelated to other medications used in the treatment of seizure disorders. This drug’s activity may be related to its ability to increase the levels of gamma-amino butyric acid (GABA) and improve its effects in the brain, and its stabilizing effect on cell membranes within the brain. These actions may also account for some of Valproic Acid’s other effects on the brain.

Valproic Acid is rapidly absorbed into the bloodstream after it is swallowed, while the absorption of Divalproex is delayed for about 1 hour until its protective coating dissolves. Valproic Acid is broken down in the liver and passes out of the body in the urine.

Do not take Valproic Acid if you are allergic to it. Use this drug with caution if you have a history of liver problems, because cases of liver failure, some resulting in death, have occurred in people taking Valproic Acid products. Children under 2 years old are especially sensitive to Valproic Acid liver failure, especially if they are taking other anticonvulsants at the same time, or if they have congenital disorders of metabolism, severe seizure disorders, mental retardation, or organic brain disease. After age 2, the chance of a fatal liver reaction decreases tremendously. Valproic Acid can also cause ammonia to be present in the bloodstream, another factor that worsens liver disease.

If it occurs, serious liver disease usually develops during the first 6 months of Valproic Acid treatment and is often preceded by feelings of ill health, weakness, tiredness, facial swelling, loss of appetite, yellow discoloration of the skin or eyes, vomiting, and loss of seizure control. Your doctor should check your liver function before starting you on Valproic Acid treatment and periodically thereafter.

Valproic Acid can affect platelet function, leading to bruising, bleeding, or changes in normal blood-clotting function.

Possible Side Effects

  • Most common: nausea, vomiting, indigestion, sedation or sleepiness, weakness, skin rash, emotional upset, depression, psychosis, aggression, and hyperactive behavior; It can also affect various blood components.
  • Less common: diarrhea, stomach cramps, constipation, increased or decreased appetite, headache, loss of eye-muscle control, drooping eyelids, double vision, spots before the eyes, loss of muscle control or coordination, and tremors.

Side effects worsen as your Valproic Acid dose increases.

Drug Interactions

  • Valproic Acid may increase the depressive effects of alcohol, sleeping pills, tranquilizers, Phenobarbital, Primidone, and other depressant drugs.
  • Dosages of Carbamazepine, Clonazepam, Ethosuximide, or Phenytoin may have to be adjusted when you begin Valproic Acid treatment.
  • Valproic Acid may affect oral anticoagulant (blood-thinning) drugs, such as Warfarin; your anticoagulant dose may have to be adjusted.
  • Aspirin, Cimetidine, and Chlorpromazine may increase the chances of Valproic Acid side effects.
  • Valproic Acid may increase the need for Levocarnitine.
  • Valproic Acid may increase the risk of bleeding or bruising if taken together with other drugs that affect platelet stickiness. Some of these are Aspirin (also increases Valproic Acid side effects), Dipyridamole, nonsteroidal anti-inflammatory drugs (NSAIDs), Sulfinpyrazone, and Ticlopidine.
  • Valproic Acid may cause false-positive reactions in ketone- urine tests (used in diabetes).

Food Interactions of Valproic Acid

Food slightly prolongs the time it takes for Valproic Acid to be absorbed into the bloodstream. Nevertheless, you may take it with food if it upsets your stomach. Do not take Divalproex (Depakote) with milk.

Depakote Sprinkle Capsules can be taken whole or mixed with a small amount (teaspoonful) of pudding, applesauce, or other soft food. The food/drug mixture should be swallowed, and not chewed, as soon as it is mixed.

Mix Valproic Acid syrup with food to make it taste better.

Valproic Acid Usual Dose

7 to 27 mg per pound per day. Valproic Acid is best taken in 1 dose at bedtime to minimize any sedation that might occur. Daily doses greater than 250 mg should be split into 2 or more doses per day.

Overdosage

Valproic Acid overdose can result in restlessness, hallucinations, flapping tremors of the hands, deep coma, or death. Call your doctor or take the victim to a hospital emergency room at once. ALWAYS bring the medicine bottle with you.

Special Information of Valproic Acid

This medicine may cause drowsiness: Be careful while driving or operating hazardous machinery.
Do not chew or crush Valproic Acid capsules or tablets.

Do not switch brands of Valproic Acid without your doctor’s knowledge. In at least 1 case, seizures resulted when a person was switched to a new product after 3 seizure-free years on another brand of Valproic Acid.

Valproic Acid can cause mouth, gum, and throat irritation or bleeding, and carries an increased risk of mouth infections. People taking this medicine should pay special attention to caring for their mouth and gums. Dental work should be delayed if your blood counts are low.

People with a seizure disorder should carry special identification indicating their condition and the drug being taken.

If you take Valproic Acid once a day and forget a dose, take it as soon as possible. If you don’t remember until the, next day, skip the forgotten dose and continue with your regular schedule.

If you take the medicine 2 or more times per day and forget a dose, and you remember within 6 hours of your regular time, take it as soon as possible. Take the rest of that day’s doses at regularly spaced time intervals. Go back to your regular schedule the next day. Do not take a double dose.

Special Populations

Pregnancy/Breast-feeding
Valproic Acid crosses into the fetal blood circulation and has caused birth defects in 1 to 2 percent of all women who take this drug during the first 3 months of pregnancy. However, most pregnant women who take Valproic Acid (as with most anticonvulsants) deliver healthy, normal babies. Anticonvulsants should be used only to control maternal seizures.
Valproic Acid passes into breast milk and may affect a nursing infant. Women who must take this drug should consider bottle-feeding their babies.

Seniors
Valproic Acid is broken down by the liver and passes out of the body through the kidneys. Because older adults tend to have reduced kidney and liver function, they often have more Valproic Acid in the bloodstream and are more likely to develop drug side effects; seniors should be treated with smaller doses of Valproic Acid.