Valproic Acid(val proe’ ik)
Valproic Acid
Apo-Valproic Acid (CAN), Gen-Valproic (CAN), PMS-Valproic Acid (CAN), ratio-Valproic (CAN), Stavzor
Capsules: DepakeneDNC
Sodium Valproate
Syrup: Depakene
Valproate Acid
Injection: Depacon
Capsules: StavzorDNC
Divalproex Sodium
Tablets: DepakoteDNC, Depakote ERDNC, Depakote Sprinkle, Divalproex, Epival (CAN)
PREGNANCY CATEGORY D
PREGNANCY CATEGORY X
(MIGRAINE PROPHYLAXIS)
Drug Class
Anticonvulsant
Therapeutic Actions
Mechanism of action not understood: Antiepileptic activity may be related to the metabolism of the inhibitory neurotransmitter, GABA; divalproex sodium is a compound containing equal proportions of valproic acid and sodium valproate.
Indications
Valproic acid: Sole and adjunctive therapy in simple (petit mal) and complex absence seizures; acute treatment of manic episodes associated with bipolar disorder; prophylaxis of migraine headaches; adjunctive therapy for multiple seizure disorders
Depakote ER: Treatment of epilepsy in children 10 yr and older; treatment of acute manic or mixed episodes associated with bipolar disorder, with or without psychotic features
Depakote ER: Treatment of bipolar mania
Depakote, Depakote ER: Prophylaxis for migraine headaches
Divalproex, sodium valproate injection: Treatment of complex partial seizures as monotherapy or with other antiepileptics
Unlabeled uses: Adjunct in symptom management of schizophrenia, treatment of aggressive outbursts in children with ADHD, organic brain syndrome, status epilepticus in children, bipolar disorder, insomnia in children and adolescents, postherpetic neuralgia, restless leg syndrome, tardive dyskenesia
Contraindications and Cautions
Contraindicated with hypersensitivity to valproic acid, hepatic disease, or significant hepatic impairment, urea cycle disorders, pancreatitis.
Use cautiously with children younger than 18 mo; children younger than 2 yr, especially with multiple antiepileptics, congenital metabolic disorders, severe seizures accompanied by severe mental retardation, organic brain disorders (higher risk of developing fatal hepatotoxicity); pregnancy (fetal neural tube defects; do not discontinue to prevent major seizures; discontinuing such medication is likely to precipitate status epilepticus, hypoxia and risk to both mother and fetus); lactation.
Available Forms
Capsules—250 mg; DR capsulesDNC—125, 250, 500 mg; syrup—250 mg/5 mL; DR tabletsDNC—125, 250, 500 mg; sprinkle capsules—125 mg; injection—100 mg/mL; ER tabletsDNC—125, 250, 500 mg
Dosages
Adults
Dosage is expressed as valproic acid equivalents. Initial dose is 10–15 mg/kg/day PO, increasing at 1-wk intervals by 5–10 mg/kg/day PO until seizures are controlled or side effects preclude further increases. Maximum recommended dosage is 60 mg/kg/day PO. If total dose exceeds 250 mg/day, give in divided doses.
Acute mania or bipolar disorder: Initially, 25 mg/kg/day PO once daily ER or 750 mg/day in divided doses of DR forms. Dose should be increased rapidly to achieve the lowest therapeutic dose. Maximum dose 60 mg/kg/day PO (Depakote ER only).
Bipolar mania: 750 mg PO daily in divided doses; do not exceed 60 mg/kg/day PO (Divalproex DR tablets only).
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