II. Indications
- Generalized Tonic Clonic Seizures
- Absence Seizures
- Myoclonic Seizures
- Simple Partial Seizures
- Complex Partial Seizures
- Migraine Headache Prophylaxis
- Bipolar Disorder (mood stabilizer)
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. Pharmacokinetics
VII. 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
VIII. Drug Interactions
- Numerous Drug Interactions
IX. Toxicity
- Large therapeutic window
- See Valproic Acid Toxicity
X. 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
XI. Pregnancy Risk
- Class D
XII. History
- Synthesized in 1882, but not recognized as an anticonvulsant until 1963
XIII. References
- Sun (2017) Crit Dec Emerg Med 31(1): 24
Images: Related links to external sites (from Bing)
Related Studies
valproic acid (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
VALPROIC ACID 250 MG CAPSULE | Generic | $0.21 each |
VALPROIC ACID 250 MG/5 ML SOLN | Generic | $0.02 per ml |
depakote (on 1/18/2023 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
DEPAKOTE DR 125 MG SPRINKLE CP | Generic | $0.27 each |
DEPAKOTE DR 250 MG TABLET | Generic | $0.07 each |
DEPAKOTE DR 500 MG TABLET | Generic | $0.13 each |
DEPAKOTE ER 250 MG TABLET | Generic | $0.16 each |
DEPAKOTE ER 500 MG TABLET | Generic | $0.20 each |