II. Indications
III. Contraindications
- Hepatic dysfunction
- Pregnancy
- Urea cycle disorder
IV. Adverse Effects: Dose related
V. Adverse Effects
- Pancreatitis
- Alopecia
- Thrombocytopenia
- Leukopenia
- Stevens-Johnson Syndrome
- Osteoporosis
- Hepatic dysfunction (in rare cases, may be fatal)
VI. Dosing: Adults
-
Seizure Disorder
- Initial: 10-15 mg/kg/day divided daily to three times daily
- Increase in 5-10 mg/kg/day increments weekly
- Target dose: 30-60 mg/kg/day to 1000-2500 mg/day
- Divide regular and delayed release dosing two to four times daily
- Extended release may be dosed once daily
-
Migraine Headache Prophylaxis
- Initial
- Depakote ER 500 mg orally daily for 7 days
- Depakote delayed release 250 mg orally twice daily
- May increase to 1000 mg/day
- Initial
-
Bipolar Disorder
- Loading dose in acute mania: 15-20 mg/kg
- Starting dose without load: 500 to 750 mg/day in divided dosing
- Titrate every 2-3 days as tolerated to serum Valproic Acid level of 50 to 125 mcg/ml
- Target dose: 1000 to 3000 mg daily in divided doses
VII. Drug Interactions
- Numerous Drug Interactions
VIII. Toxicity
- Large therapeutic window
IX. Monitoring
- Serum Valproate level
- Initial: Every 1-2 weeks
- Later: Every 3-6 months
- Other routine monitoring
- Obtain monthly for 2 months and then every 3 to 12 months
- Complete Blood Count
- Liver Function Tests
X. Pregnancy Risk
- Class D
XI. History
- Synthesized in 1882, but not recognized as an anticonvulsant until 1963
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| valproic acid (on 5/17/2017 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| VALPROIC ACID 250 MG CAPSULE | Generic | $0.19 each |
| VALPROIC ACID 250 MG/5 ML SOLN | Generic | $0.03 per ml |
| depakote (on 12/26/2016 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| DEPAKOTE DR 125 MG SPRINKLE CP | Generic | $0.54 each |
| DEPAKOTE DR 125 MG TABLET | Generic | $0.05 each |
| DEPAKOTE DR 250 MG TABLET | Generic | $0.08 each |
| DEPAKOTE DR 500 MG TABLET | Generic | $0.14 each |
| DEPAKOTE ER 250 MG TABLET | Generic | $0.82 each |
| DEPAKOTE ER 500 MG TABLET | Generic | $0.62 each |
| depakene (on 12/26/2016 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| DEPAKENE 250 MG/5 ML SOLUTION | $0.96 per ml | |
Ontology: Valproate (C0080356)
| Definition (CSP) | fatty acid with anticonvulsant properties. |
| Concepts | Pharmacologic Substance (T121) , Lipid (T119) |
| MSH | D014635 |
| SnomedCT | 264325000, 372812003, 67477004 |
| LNC | LP16305-2, MTHU005126 |
| English | 2 propylvalerate, valproate, Valproate product, Valproate (product), Valproate (substance), Valproate |
| French | Valproate |
| Spanish | valproato (producto), valproato (sustancia), valproato |
Ontology: Depakene (C0700661)
| Concepts | Pharmacologic Substance (T121) , Lipid (T119) |
| MSH | D014635 |
| English | Depakine, depakene, depakine, Depakene |
Ontology: Depakote (C0719751)
| Definition (CHV) | a kind of epilepsy treatment drug |
| Concepts | Pharmacologic Substance (T121) , Lipid (T119) |
| MSH | D014635 |
| English | depakote, Depakote |
