Pharm
Valproate
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Valproate
, Valproic Acid, Depakote, Depakene
Indications
Generalized Tonic Clonic Seizure
s
Absence Seizure
s
Myoclonic
Seizure
s
Simple Partial Seizure
s
Complex Partial Seizure
s
Migraine Headache Prophylaxis
Mania
Contraindications
Hepatic dysfunction
Pregnancy
Urea cycle disorder
Adverse Effects
Dose related
Nausea
and
Vomiting
Tremor
Ataxia
Diarrhea
Lethargy or sedation
Mild
Liver Function Test
abnormalities (AST, ALT)
Weight gain
Adverse Effects
Pancreatitis
Alopecia
Centrum A-
Zinc
daily prevents associated
Hair Loss
Thrombocytopenia
Leukopenia
Stevens-Johnson Syndrome
Osteoporosis
Hepatic dysfunction (in rare cases, may be fatal)
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
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
Drug Interactions
Numerous
Drug Interaction
s
Toxicity
Large therapeutic window
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 Test
s
Pregnancy Risk
Class D
History
Synthesized in 1882, but not recognized as an anticonvulsant until 1963
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