valproic acid (cont.)
NURSING MOTHERS: The concentration of valproic acid in
breast milk of women taking valproic acid is 1-10%. Although the effect on the baby is not certain nursing mothers probably should not breast feeding if they are taking valproic acid.
SIDE EFFECTS: The most common side effects with valproic acid therapy are drowsiness, dizziness, nausea,
vomiting, indigestion, diarrhea, weight loss and tremors. 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.
Reference: FDA Prescribing Information
Last Editorial Review: 1/10/2006
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