Generic Name: valproic acid (val PRO ik A sid)
Brand names: Depakene, Stavzor, Depacon
What is valproic acid?
Valproic acid affects chemicals in the body that may be involved in causing seizures.
Valproic acid is used to treat various types of seizure disorders. Valproic acid is sometimes used together with other seizure medications.
Valproic acid may also be used for purposes not listed in this medication guide.
What is the most important information I should know about valproic acid?
Valproic acid may cause harm to an unborn baby, but having a seizure during pregnancy could harm both the mother and the baby.
Valproic acid may also affect cognitive development in children born to mothers who take this medication during pregnancy. Studies have shown that these children may score lower on cognitive tests (reasoning, intelligence, and problem-solving) than children whose mothers took other seizure medications during pregnancy.
Tell your doctor right away if you become pregnant while taking valproic acid for seizures. Do not start or stop taking valproic acid during pregnancy without your doctor's advice. In rare cases, valproic acid has caused life-threatening liver failure, especially in children younger than 2 years old.
Valproic acid has also caused rare cases of life-threatening pancreatitis (inflammation of the pancreas). Pancreatitis can come on suddenly and symptoms may start even after you have been taking valproic acid for several years.
Seek emergency medical attention if the person taking this medicine has nausea, vomiting, upper stomach pain, or loss of appetite, low fever, dark urine, clay-colored stools, or jaundice (yellowing of the skin or eyes). These symptoms may be early signs of liver damage. Some of these symptoms may also be early signs of pancreatitis.
You may have thoughts about suicide while taking this medication. Your doctor will need to check you at regular visits. Do not miss any scheduled appointments.
Report any new or worsening symptoms to your doctor, such as: mood or behavior changes, depression, anxiety, or if you feel agitated, hostile, restless, hyperactive (mentally or physically), or have thoughts about suicide or hurting yourself.
What should I discuss with my healthcare provider before taking valproic acid?
In rare cases, valproic acid has caused life-threatening liver failure, especially in children younger than 2 years old. Children of this age may be at even greater risk for liver problems if they use more than one seizure medication, if they have a metabolic disorder, or if they have a brain disease causing mental impairment (such as Creutzfeldt-Jacob disease, Huntington disease, multiple sclerosis, or a brain injury or infection). Valproic acid has also caused rare cases of life-threatening pancreatitis (inflammation of the pancreas). Pancreatitis can come on suddenly and symptoms may start even after you have been taking valproic acid for several years. Do not take valproic acid if you have liver disease or a urea cycle disorder. You should not take this medication if you are allergic to valproic acid, or if you have severe liver disease or a urea cycle disorder.
To make sure you can safely take valproic acid, tell your doctor if you have any of these other conditions:
liver disease;
a bleeding or blood clotting disorder;
a history of head injury, brain disorder, or coma;
a family history of a urea cycle disorder;
a family history of infant deaths with unknown cause; or
HIV or CMV (cytomegalovirus) infection.
Your family or other caregivers should also be alert to changes in your mood or symptoms. Your doctor will need to check you at regular visits. Do not miss any scheduled appointments.
You may have thoughts about suicide while taking this medication. Tell your doctor if you have new or worsening depression or suicidal thoughts during the first several months of treatment, or whenever your dose is changed.
FDA pregnancy category D. Valproic acid can cause birth defects. Do not start taking valproic acid without telling your doctor if you are pregnant or planning to become pregnant. Use effective birth control while you are taking valproic acid.
Valproic acid may also affect cognitive development in children born to mothers who take this medication during pregnancy. Studies have shown that these children may score lower on cognitive tests (reasoning, intelligence, and problem-solving) than children whose mothers took other seizure medications during pregnancy.
Although valproic acid may harm an unborn baby, having a seizure during pregnancy could harm both mother and baby. If you become pregnant while taking valproic acid, do not stop taking the medicine without your doctor's advice. Seizure control is very important during pregnancy. The benefit of preventing seizures may outweigh any risks posed by taking valproic acid. There may be other seizure medications that can be more safely used during pregnancy. Follow your doctor's instructions about taking valproic acid while you are pregnant. Valproic acid can pass into breast milk and may harm a nursing baby. You should not breast-feed while you are using valproic acid.
How should I take valproic acid?
Take exactly as prescribed by your doctor. Do not take in larger or smaller amounts or for longer than recommended. Follow the directions on your prescription label.
Drink plenty of water while you are taking this medication. Your dose may need to be changed if you do not get enough fluids each day.
Measure liquid medicine with a special dose measuring spoon or medicine cup, not with a regular table spoon. If you do not have a dose measuring device, ask your pharmacist for one.
To be sure this medication is not causing harmful effects, your liver function will need to be tested often. Visit your doctor regularly.
Do not stop using valproic acid without first talking to your doctor, even if you feel fine. You may have increased seizures if you stop using valproic acid suddenly. You may need to use less and less before you stop the medication completely. Swallow the capsule whole. Do not crush, chew, or break a capsule because the medicine may irritate your mouth or throat when you swallow it. Wear a medical alert tag or carry an ID card stating that you take valproic acid. Any medical care provider who treats you should know that you are taking a seizure medication. Store at room temperature away from moisture and heat.
See also: Valproic acid dosage (in more detail)
What happens if I miss a dose?
Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.
What happens if I overdose?
Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.
Overdose symptoms may include sleepiness or drowsiness, shallow breathing, weak pulse, or loss of consciousness.
What should I avoid while taking valproic acid?
Drinking alcohol can increase certain side effects of valproic acid. Valproic acid may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert. Avoid exposure to sunlight or tanning beds. Valproic acid can make you sunburn more easily. Wear protective clothing and use sunscreen (SPF 30 or higher) when you are outdoors.
Valproic acid side effects
Seek emergency medical attention if the person taking this medicine has nausea, vomiting, upper stomach pain, or loss of appetite, low fever, dark urine, clay-colored stools, or jaundice (yellowing of the skin or eyes). These symptoms may be early signs of liver damage. Some of these symptoms may also be early signs of pancreatitis.
Report any new or worsening symptoms to your doctor, such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.
Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Call your doctor at once if you have any of these other serious side effects:
unexplained weakness with vomiting and confusion or fainting;
easy bruising or bleeding, blood in your urine;
fever, chills, body aches, swollen glands, flu symptoms;
urinating less than usual;
hallucinations (seeing things that aren't there);
extreme drowsiness, lack of coordination;
double vision or back-and-forth movements of the eyes; or
severe skin reaction -- fever, sore throat, swelling in your face or tongue, burning in your eyes, skin pain, followed by a red or purple skin rash that spreads (especially in the face or upper body) and causes blistering and peeling.
Less serious side effects may include:
mild drowsiness or weakness;
diarrhea, constipation, upset stomach;
changes in your menstrual periods;
enlarged breasts;
tremor (shaking);
hair loss;
weight changes;
vision changes; or
unusual or unpleasant taste in your mouth.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
Valproic acid Dosing Information
Usual Adult Dose for Seizure Prophylaxis:
Valproate sodium injection:
Initial dose: 10 to 15 mg/kg/day intravenously divided over 4 doses administered every 6 hours.
Maintenance dose: 30 to 60 mg/kg/day intravenously divided over 4 doses administered every 6 hours.
Intravenous doses may be broken into 2 to 3 divided doses/day. However, if this frequency is chosen, trough levels should be carefully monitored.
Use of valproate sodium injection for periods of more than 14 days has not been studied. Patients should be switched to oral valproate products as soon as it is clinically feasible.
Capsules or syrup:
Initial dose: 10 to 15 mg/kg/day orally in 1 to 3 divided doses
Maintenance dose: 30 to 60 mg/kg/day orally in 2 to 3 divided doses
Total daily doses in excess of 250 mg should be given in divided doses.
Usual Adult Dose for Mania:
Initial dose: 750 mg valproic acid delayed release capsules orally daily in divided doses. Delayed release capsules must be swallowed whole.
The dose should be increased as rapidly as possible to achieve the lowest therapeutic dose which produces the desired clinical effect or the desired range of plasma concentrations. In placebo-controlled clinical trials of acute mania, patients were dosed to a clinical response with a trough plasma concentration between 50 and 125 mcg per mL. Maximum concentrations were generally achieved within 14 days.
The maximum recommended dosage is 60 mg/kg/day.
There is no body of evidence available from controlled trials to guide a clinician in the longer-term management of a patient who improves during valproic acid delayed release capsules treatment of an acute manic episode. While it is generally agreed that pharmacological treatment beyond an acute response in mania is desirable, both for maintenance of the initial response and for prevention of new manic episodes, there are no systematically obtained data to support the benefits of valproic acid delayed release capsules in such longer-term treatment.
Usual Adult Dose for Migraine Prophylaxis:
Initial dose: 250 mg valproic acid delayed release capsules orally twice daily. Valproic acid delayed release capsules must be swallowed whole.
Some patients may benefit from doses up to 1000 mg/day. In clinical trials, there was no evidence that higher doses led to greater efficacy.
Usual Pediatric Dose for Seizure Prophylaxis:
Limited data are available for neonatal dosing; further studies are needed.
Refractory seizures: Oral: Loading dose: 20 to 25 mg/kg, followed by a maintenance dose of 5 to 10 mg/kg every 12 hours; a report of 6 neonates (30-41 weeks gestation) showed oral valproic acid effectively controlled seizure activity in 5 of 6 patients; therapy was discontinued in 50% of the patients due to hyperammonemia; frequent monitoring is recommended.
Refractory status epilepticus: IV: Loading dose: 20 to 40 mg/kg followed by a continuous infusion of 5 mg/kg/hour was used in 5 neonates; once patients were seizure free for 12 hours and no longer had seizure activity on EEG, the infusion rate was decreased every 2 hours by 1 mg/kg/hour.
Note: Use of Depakote-ER (R) in pediatric patients less than 10 years of age is not recommended; do not confuse Depakote-ER (R) with Depakote (R). Erroneous substitution of Depakote (R) (delayed release tablets) for Depakote-ER (R) has resulted in toxicities; only Depakote-ER (R) is intended for once daily administration.
Seizures disorders: Children and Adults:
Oral: Initial: 10 to 15 mg/kg/day in 1 to 3 divided doses; increase by 5 to 10 mg/kg/day at weekly intervals until therapeutic levels are achieved; maintenance: 30 to 60 mg/kg/day in 2 to 3 divided doses; Depakote (R) and Depakote (R) Sprinkle can be given twice daily.
Note: Children receiving more than 1 anticonvulsant (i.e., polytherapy) may require doses up to 100 mg/kg/day in 3 to 4 divided doses. Due to differences in bioavailability, children greater than or equal to 10 years of age and adult epilepsy patients receiving Depakote (R) may be switched to Depakote-ER (R) by using a once daily Depakote-ER (R) dose that is 8 to 20% higher than the total daily dose of Depakote (R) (see Depakote-ER (R) package insert for details).
IV: Total daily IV dose is equivalent to the total daily oral dose, however, IV dose should be divided with a frequency of every 6 hours; if IV form is administered 2 to 3 times/day, close monitoring of trough levels is recommended; switch patients to oral product as soon as possible (IV use has not been studied for greater than 14 days).
Rectal: Dilute syrup 1:1 with water for use as a retention enema; loading dose: 17 to 20 mg/kg one time; maintenance: 10 to 15 mg/kg/dose every 8 hours.
Refractory status epilepticus:
Infants and Children:
IV: Loading dose: Initial: Optimal dosage is not established; pediatric studies have used initial loading doses of 20 to 40 mg/kg.
Note: In one retrospective study, an initial loading dose of 25 mg/kg administered 3 mg/kg/minute was effective in stopping seizure activity within 20 minutes after the end of the infusion in all 18 patients treated for status epilepticus. A separate retrospective trial found a higher efficacy rate in pediatric patients (n=41) who received an initial loading dose of 30 to 40 mg/kg (compared to 20 to 30 mg/kg or greater than 40 mg/kg). In an open label, randomized comparative trial, an initial loading dose of 30 mg/kg was administered (n=20; age range: 7 months to 10 years of age; mean age: 3 years); a repeat bolus of 10 mg/kg could be administered if seizures were not controlled within 10 minutes; mean required dose: 37.5 plus or minus 4.4 mg/kg; median required dose: 40 mg/kg. Further studies are needed.
IV: Maintenance dose: IV infusion: Optimal dosage is not established; pediatric studies used continuous infusions of 5 mg/kg/hour after the loading dose; once patients were seizure free for 6 hours, the infusion rate was decreased by 1 mg/kg/hour every 2 hours. Further studies are needed.
What other drugs will affect valproic acid?
Cold or allergy medicine, narcotic pain medicine, sleeping pills, muscle relaxers, and medicine for depression or anxiety can add to sleepiness caused by valproic acid. Tell your doctor if you regularly use any of these medicines, or any other seizure medication.
Tell your doctor about all other medications you use, especially:
topiramate (Topamax);
tolbutamide (Orinase);
a blood thinner such as warfarin (Coumadin, Jantoven);
aspirin or acetaminophen (Tylenol);
zidovudine (Retrovir);
clozapine (Clozaril, FazaClo);
diazepam (Valium);
meropenem (Merrem) or imipenem and cilastatin (Primaxin);
rifampin (Rifadin, Rimactane, Rifater); or
ethosuximide (Zarontin).
This list is not complete and other drugs may interact with valproic acid. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.
More valproic acid resources
- Valproic acid Side Effects (in more detail)
- Valproic acid Dosage
- Valproic acid Use in Pregnancy & Breastfeeding
- Drug Images
- Valproic acid Drug Interactions
- Valproic acid Support Group
- 10 Reviews for Valproic acid - Add your own review/rating
- valproic acid Advanced Consumer (Micromedex) - Includes Dosage Information
- Valproic Acid Monograph (AHFS DI)
- Valproic Acid MedFacts Consumer Leaflet (Wolters Kluwer)
- Depacon Prescribing Information (FDA)
- Depacon Advanced Consumer (Micromedex) - Includes Dosage Information
- Depacon MedFacts Consumer Leaflet (Wolters Kluwer)
- Depakene Prescribing Information (FDA)
- Stavzor Prescribing Information (FDA)
- Stavzor Consumer Overview
- Stavzor Delayed-Release Capsules MedFacts Consumer Leaflet (Wolters Kluwer)
Compare valproic acid with other medications
- Bipolar Disorder
- Hyperekplexia
- Mania
- Migraine Prevention
- Schizoaffective Disorder
- Seizure Prevention
- Seizures
Where can I get more information?
- Your pharmacist can provide more information about valproic acid.
See also: valproic acid side effects (in more detail)
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