VALPROIC acid = SODIUM VALPROATE oral

Therapeutic action

– Antiepileptic

Indications

– Epilepsy (generalised and partial seizures)
– Prevention of recurrence of bipolar disorder 

Forms and strengths

– 200 mg and 500 mg enteric coated tablets
– 200 mg/5 ml oral solution

Dosage

– Epilepsy (generalised and partial seizures)
• Child under 20 kg: 10 mg/kg 2 times daily
• Child over 20 kg: start with 200 mg (irrespective of weight) 2 times daily, then increase gradually until the optimal dose for the individual patient is reached, usually 10 to 15 mg/kg 2 times daily
• Adult: start with 300 mg 2 times daily, then increase by 200 mg every 3 days until the optimal dose for the individual patient is reached, usually 500 to 1000 mg 2 times daily

– Prevention of recurrence of bipolar disorder 
Adult: start with 200 mg 2 times daily. Increase if necessary until the optimal dose for the individual patient is reached, usually around 500 mg 2 times daily (max. 1000 mg 2 times daily).

Duration

– Lifetime treatment

Contra-indications, adverse effects, precautions

– Do not administer:
• to women of childbearing age. If the treatment is absolutely necessary and if there is no alternative, an effective contraception is required (intrauterine device);
• to patients with pancreatitis, hepatic disease or history of hepatic disease.
– May cause:
• increase in the frequency of seizures at the beginning of therapy, drowsiness, weight gain, amenorrhoea, gastrointestinal disturbances, extrapyramidal symptoms, behavioural disturbances, confusion, thrombocytopenia;
• rarely: pancreatitis, hepatic disorders, severe allergic reactions (Lyell’s and Stevens-Johnson syndromes), prolongation of bleeding time. In these cases, stop treatment.
– Monitor, if possible, liver transaminases and prothrombin time during first 3-6 months of therapy (risk of hepatitis).
– Reduce dosage in patients with renal impairment.
– Do not combine with mefloquine (increased risk of seizures).
– Monitor combination with: tricyclic antidepressants, other antiepileptics.
– If other antiepileptics have been prescribed, increase the dose of valproic acid gradually over 2 weeks and reduce the dose of other antiepileptics.
– Pregnancy: do not start treatment during pregnancy (risk of neural tube defects; urogenital, limb and face malformations; psychomotor developmental disorders). If treatment was started before pregnancy: replace valproic acid with a safer antiepileptic.
– Breast-feeding: no contra-indication

Remarks

– Take with meals.
– Also comes in 100 mg crushable tablets.
– Storage: below 25 °C -  -