SIDE EFFECTS: The most common side effects with valproic acid therapy are:
Divalproex may have a lower incidence of stomach upset, and taking valproic acid or divalproex with food can reduce the stomach upset. Valproic acid also causes skin reactions such as alopecia (loss of hair), rash, itching and sensitivity to sunlight.
The most serious side effects due to valproic acid are liver injury, pancreatitis and abnormal bleeding. Liver injury is most common in the first 6 months of treatment. It also is more common in children, especially children less than two years old. Persons taking more than one type of anticonvulsant seem to be at higher risk. Symptoms of liver damage include jaundice, malaise, weakness, swelling in the face, loss of appetite and vomiting. Pancreatitis due to valproic acid can occur early in treatment or after several years of use. Symptoms of pancreatitis are unexplained weight loss, nausea, vomiting and severe abdominal pain. Valproic acid inhibits the formation of blood clots by interfering with the clot-promoting effects of platelets. This can cause abnormal bleeding.
Antiepileptic medications have been associated with an increased risk of suicidal thinking and behavior. Anyone considering the use of antiepileptic drugs must balance this risk of suicide with the clinical need for the antiepileptic drug. Patients who begin antiepileptic therapy should be closely observed for clinical worsening, suicidal thoughts or unusual changes in behavior.
GENERIC AVAILABLE: Yes
- Delayed release tablets: 125, 250 and 500 mg.
- Extended release tablets: 250 and 500 mg.
- Sprinkle capsules: 125 mg.
- Capsules: 250 mg.
- Syrup: 250 mg/5 ml.
- Injection: 100 mg/5 ml.
STORAGE: Valproic acid should be stored at room temperature, 15 C - 30 C (59 F - 86 F).
DOSING: For seizures, therapy is initiated at 10-15 mg/kg/day and increased by 5-10 mg/kg/day every week to achieve the desired response. Response usually is seen when the blood concentration of valproic acid is 50-100 mcg/mL.
For acute mania due to bipolar disorder, treatment is started at 750 mg per day of delayed-release tablets in divided doses. The dose should be increased rapidly to achieve the desired effect. The maximum dose is 60 mg/kg/day.
The recommended dose for prevention of migraines is 250 mg twice daily of delayed-release tablets. The maximum recommended dose is 1000 mg/day. When using extended release tablets, the recommended dose is 500-1000 mg given once daily.
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