- What is valproic acid, and how does it work (mechanism of action)?
- What brand names are available for valproic acid?
- Is valproic acid available as a generic drug?
- Do I need a prescription for valproic acid?
- What are the side effects of valproic acid?
- What is the dosage for valproic acid?
- Which drugs or supplements interact with valproic acid?
- Is valproic acid safe to take if I'm pregnant or breastfeeding?
- What else should I know about valproic acid?
What is valproic acid, and how does it work (mechanism of action)?
Valproic acid and its derivative, divalproex, are oral drugs that are used for the treatment of convulsions, migraines and bipolar disorder. The active ingredient in both products is valproic acid. Divalproex is converted to valproic acid in the stomach. Scientists do not know the mechanism of action of valproic acid. The most popular theory is that valproic acid exerts its effects by increasing the concentration of gamma-aminobutyric acid (GABA) in the brain. GABA is a neurotransmitter, a chemical that nerves use to communicate with one another. The FDA approved valproic acid in February, 1978 and divalproex in March 1983.
What brand names are available for valproic acid?
Depakote, Depakote ER, Depakote Sprinkle, Depakene, Depacon, Stavzor
What are the side effects of valproic acid?
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.
What is the dosage for valproic acid?
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.
Which drugs or supplements interact with valproic acid?
Valproic acid has numerous suspected or proven drug interactions. Valproic acid can reduce the number of platelets or inhibit the ability of platelets to stick together and form a blood clot. Therefore, it may exaggerate the effects of other medications which inhibit the stickiness of platelets or inhibit other steps in the clotting of blood. This can lead to abnormal bleeding due to the inability of blood to clot. Such medications include warfarin (Coumadin), heparin or low-molecular weight heparin (Lovenox), clopidogrel (Plavix), ticlopidine (Ticlid), and nonsteroidal antiinflammatory drugs (NSAIDs) such as ibuprofen (Motrin, Advil), naproxen (Naprosyn, Aleve), indomethacin (Indocin), nabumetone (Relafen), diclofenac (Voltaren, Cataflam, Arthrotec), ketorolac (Toradol) and aspirin.
Rifampin (Rifadin, Rimactane), carbamazepine (Tegretol), phenytoin (Dilantin) can increase the elimination of valproic acid, thereby reducing blood concentrations. Since this can result in loss of seizure control and seizures, adjustments in the dose of valproic acid may be necessary if these medications are begun.
Cholestyramine (Questran) can reduce the absorption of valproic acid from the intestine and reduce its effectiveness. Therefore, valproic acid should be taken at least 2 hours before or 6 hours after doses of cholestyramine.
Valproic acid can significantly decrease the elimination of lamotrigine (Lamictal), ethosuximide (Zarontin), diazepam (Valium), zidovudine (AZT) and phenobarbital, thereby increasing their concentrations in blood and leading to toxicity. Valproic acid also increases the blood levels of warfarin and phenytoin by displacing them from blood proteins that they bind to. Since increased blood concentrations of these drugs may lead to an increase in side effects, the dose of warfarin and phenytoin may need to be altered when they are taken with valproic acid.
Is valproic acid safe to take if I'm pregnant or breastfeeding?
The use of valproic acid during pregnancy has been associated with fetal abnormalities such as spina bifida, cardiovascular abnormalities, and neural tube defects. The risk of spina bifida in the offspring of mothers taking valproic acid during pregnancy is 1%-2%. Valproic acid also may cause reduced clotting in the mother and baby. Because of the risk of harm to the newborn, valproic acid should only be used by pregnant women when its benefits outweigh the risks.
The concentration of valproic acid in breast milk of women taking valproic acid is 1-10%. Although the effect on the nursing infant, is not certain, nursing mothers probably should not breastfeeding if they are taking valproic acid.
What else should I know about valproic acid?
What preparations of valproic acid are available?
- 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.
How should I keep valproic acid stored?
Valproic acid should be stored at room temperature, 15 C - 30 C (59 F - 86 F).
Subscribe to MedicineNet's General Health Newsletter
Valproic acid, divalproex (Depakote, Depakote ER, Depakene, Depakote Sprinkle, Depacon, Stavzor) is a medication prescribed for the treatment of seizures, bipolar disorder, and prevention of migraine headaches. Side effects, drug interactions, warnings and precautions, pregnancy information, and patient information should be reviewed prior to taking any drug.
Multimedia: Slideshows, Images & Quizzes
Depression Quiz: Signs & Symptoms
Many people do not recognize the symptoms and warning signs of depression and depressive disorders in children and adults. With...
Dementia, Alzheimer's Disease, and Aging Brains
What is dementia? Learn about dementia disorders such as Lewy Body Dementia, Alzheimer's disease (AD), Vascular (multi-infarct)...
Related Disease Conditions
Depression is an illness that involves the body, mood, and thoughts and affects the way a person eats and sleeps, the way one...
Migraine headache is a type of headache associated with a sensitivity to light, smells, or sounds, eye pain, severe pounding on...
Epilepsy is a brain disorder in which the person has seizures. There are two kinds of seizures, focal and generalized. There are...
Pregnancy and Drugs (Prescription and OTC)
Taking prescription medications or over-the-counter drugs or supplements should be discussed with your doctor. There are some...
Headaches can be divided into two categories: primary headaches and secondary headaches. Migraine headaches, tension headaches,...
Bipolar disorder (or manic depression) is a mental illness characterized by depression, mania, and severe mood swings. Treatment...
Borderline Personality Disorder (BPD)
Borderline personality disorder is a serious mental illness characterized by pervasive instability in moods, interpersonal...
Obsessive Compulsive Disorder (OCD)
Obsessive compulsive disorder (OCD) is an anxiety disorder that causes a person to suffer repeated obsessions and compulsions....
Postpartum depression is a form of depression that occurs within a year after delivery. It is thought that rapid hormone changes...
Cluster headaches are a type of headache that recurs over a period. Episodes can last one to three times a day during this time,...
Seizures Symptoms and Types
Seizures are divided into two categories: generalized and partial. Generalized seizures are produced by electrical impulses from...
Drug-Induced Liver Disease
Drug-induced liver diseases are diseases of the liver that are caused by: physician-prescribed medications, OTC...
Fragile X Syndrome
Fragile X syndrome is the most common inherited form of mental retardation. It's caused by a mutation on the X chromosome. People...
Bipolar Disorder in Children and Teens
Bipolar disorder, or manic-depressive illness, is a disorder that causes unusual and extreme mood changes. Symptoms of bipolar...
Abdominal Migraines in Children and Adults
Abdominal migraine in adults and children is a variant of migraine headaches. Abdominal migraine in children generally occurs in...
Misophonia is defined as the hatred of sound. Symptoms of this condition include a negative emotional response to certain trigger...
Bipolar Disorder vs. Schizophrenia
Bipolar disorder and schizophrenia are mental illnesses that share some risk factors and treatments. Symptoms of bipolar disorder...
Compulsive Overeating vs. Binge Eating Disorder
Compulsive overeating is eating more than needed. Binge eating disorder involves recurrent episodes of compulsive eating, even...
Treatment & Diagnosis
- Depression FAQs
- Drugs: The Most Common Medication Errors
- How To Reduce Your Medication Costs
- Pharmacy Visit, How To Get The Most Out of Your Visit
- Indications for Drugs: Approved vs. Non-approved
- Drugs: Buying Prescription Drugs Online Safely
- Medication Disposal
- Dangers of Mixing Medications
- Posttraumatic Stress Disorder and 9-11
- Catherine Zeta-Jones: A Case of Bipolar II Disorder
- Generic Drugs, Are They as Good as Brand-Names?
Medications & Supplements
Prevention & Wellness
- More Evidence Preterm Birth Could Raise Autism Risk
- Study Ties Autism Risk to Prenatal Exposure to Asthma Drugs
- Antipsychotics May Be Deadlier Than Thought for Dementia Patients
- Study Weighs Safety of Epilepsy Drugs in Pregnancy
- Obesity May Increase Migraine Odds
- Could Food Flavors Act Like Mood-Stabilizing Drugs?
- Prescription Meds Can Put on Unwanted Pounds
- Seizure Drug May Extend Lives of Brain Cancer Patients
- Study: Low Birth Defect Risk From Newer Epilepsy Drugs
- Birth Defects Linked to Valproic Acid
Health Solutions From Our Sponsors
Report Problems to the Food and Drug Administration
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.
FDA Prescribing Information