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Valproic acid

Generic name: Valproic acid
Brand names: Depakene

Why is Valproic acid prescribed?

Valproic acid, an epilepsy medicine, is used to treat certain types of seizures and convulsions. It may be prescribed alone or with other anticonvulsant medications.

Most important fact about Valproic acid

Valproic acid can cause serious, even fatal, liver damage, especially during the first 6 months of treatment. Children under 2 years of age are the most vulnerable, especially if they are also taking other anticonvulsant medicines and have certain other disorders such as mental retardation. The risk of liver damage decreases with age; but you should always be alert for the following symptoms: loss of seizure control, weakness, dizziness, drowsiness, a general feeling of ill health, facial swelling, loss of appetite, vomiting, and yellowing of the skin and eyes. If you suspect a liver problem, call your doctor immediately.

Note too that Valproic acid has been known to cause rare cases of life-threatening damage to the pancreas. This problem can develop at any time, even after years of treatment. Call your doctor immediately if any of the following warning signs appear: abdominal pain, loss of appetite, nausea, and vomiting.

How should you take Valproic acid?

If Valproic acid irritates your digestive system, take it with food. To avoid irritating your mouth and throat, swallow Valproic acid capsules whole; do not chew them.

--If you miss a dose...

If you take 1 dose a day, take the dose you missed as soon as you remember. If you do not remember until the next day, skip the dose you missed and go back to your regular schedule.

If you take more than 1 dose a day and you remember the missed dose within 6 hours of the scheduled time, take it immediately. Take the rest of the doses for that day at equally spaced intervals. Never take 2 doses at once.

--Storage instructions...

Store at room temperature.

What side effects may occur?

Side effects are more likely if you are taking more than one epilepsy medication, and when you are taking higher doses of Valproic acid. Indigestion, nausea, and vomiting are the most common side effects when you first start taking Valproic acid.

If any side effects develop or change in intensity, inform your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue taking Valproic acid.

• More common side effects may include:
  Abdominal cramps, amnesia, breathing difficulty, depression, diarrhea, dimmed or blurred vision, drowsiness, hair loss, indigestion, infection, involuntary eye movements, loss or increase in appetite, nausea, nervousness, ringing in the ears, sleeplessness, swelling of the arms and legs due to fluid retention, throat inflammation, tremors, vomiting

Why should Valproic acid not be prescribed?

You should not take Valproic acid if you have liver disease or your liver is not functioning properly, or if you have had an allergic reaction to it.

Special warnings about Valproic acid

Remember that liver failure is possible when taking Valproic acid (see "Most important fact about Valproic acid"). Your doctor should test your liver function at regular intervals.

Also keep in mind the threat of damage to the pancreas (see "Most important fact about Valproic acid"). This problem can develop rapidly, so contact your doctor immediately if you experience any symptoms.

In people with a rare set of genetic abnormalities called urea cycle disorders, Valproic acid may adversely effect the brain. Signs of a developing problem include lack of energy, repeated attacks of vomiting, and mental changes. If you suspect a problem, see your doctor immediately. Valproic acid may have to be discontinued.

Valproic acid has also been known to cause a very rare but potentially fatal skin condition. Contact your doctor if you notice any changes in your skin.

Some side effects are more likely if you have manic episodes or suffer from migraines. Your doctor will monitor your care closely if you have one of these conditions.

Because of the potential for side effects involving blood disorders, your doctor will probably test your blood before prescribing Valproic acid and at regular intervals while you are taking it. Bruising, hemorrhaging, or clotting disorders usually mean the dosage should be reduced or the drug should be stopped altogether.

Valproic acid may cause drowsiness, especially in older adults. You should not drive a car, operate heavy machinery, or engage in hazardous activity until you know how you react to the drug.

Do not abruptly stop taking this medicine without first consulting your doctor. A gradual reduction in dosage is usually required to prevent major seizures.

This drug can also increase the effect of painkillers and anesthetics. Before any surgery or dental procedure, make sure the doctor knows you are taking Valproic acid.

Possible food and drug interactions when taking Valproic acid

If Valproic acid is taken with certain other drugs, the effects of either could be increased, decreased, or altered. It is especially important to check with your doctor before combining Valproic acid with the following:

Amitriptyline (Elavil)
Aspirin
Barbiturates such as phenobarbital and Seconal
Blood-thinning drugs such as Coumadin and Dicumarol
Carbamazepine (Tegretol)
Clonazepam (Klonopin)
Diazepam (Valium)
Ethosuximide
Felbamate (Felbatol)
Lamotrigine (Lamictal)
Merrem IV (meropenem for injection)
Nortriptyline (Pamelor)
Phenytoin (Dilantin)
Primidone (Mysoline)
Rifampin (Rifater)
Tolbutamide (Orinase)
Zidovudine (Retrovir)

Extreme drowsiness and other serious effects may occur if Valproic acid is taken with alcohol or other central nervous system depressants such as Halcion, Restoril, or Xanax.

Special information if you are pregnant or breastfeeding

If taken during pregnancy, Valproic acid may harm the baby. The drug is not recommended for pregnant women unless the benefits of therapy clearly outweigh the risks. In fact, women in their childbearing years should take Valproic acid only if it has been shown to be essential in the control of seizures. Since Valproic acid appears in breast milk, nursing mothers should use it only with caution.

Recommended dosage

ADULTS AND CHILDREN 10 OR OLDER

The usual starting dose is 10 to 15 milligrams per 2.2 pounds of body weight per day. Your doctor may increase the dose at weekly intervals by 5 to 10 milligrams per 2.2 pounds per day until seizures are controlled or side effects become too severe. If stomach upset develops, the dose may be increased more slowly. The daily dose should not exceed 60 milligrams per 2.2 pounds per day.

OLDER ADULTS

Older adults generally are prescribed reduced starting doses, and receive dosage increases more gradually than younger people.

Overdosage

Any medication taken in excess can have serious consequences. An overdose of Valproic acid can be fatal. If you suspect an overdose, seek medical help immediately.

• Symptoms of Valproic acid overdose may include:
  Coma, extreme drowsiness, heart problems