III. Contraindications

  1. Hepatic dysfunction
  2. Pregnancy
  3. Urea cycle disorder

IV. Adverse Effects: Dose related

  1. Nausea and Vomiting
  2. Tremor
  3. Ataxia
  4. Diarrhea
  5. Lethargy or Sedation
  6. Mild Liver Function Test abnormalities (AST, ALT)
  7. Weight gain

V. Adverse Effects

  1. Pancreatitis
  2. Alopecia
    1. Centrum A-Zinc daily prevents associated Hair Loss
  3. Thrombocytopenia
  4. Leukopenia
  5. Stevens-Johnson Syndrome
  6. Osteoporosis
  7. Hepatic dysfunction (in rare cases, may be fatal)

VI. Dosing: Adults

  1. Seizure Disorder
    1. Initial: 10-15 mg/kg/day divided daily to three times daily
    2. Increase in 5-10 mg/kg/day increments weekly
    3. Target dose: 30-60 mg/kg/day to 1000-2500 mg/day
      1. Divide regular and delayed release dosing two to four times daily
      2. Extended release may be dosed once daily
  2. Migraine Headache Prophylaxis
    1. Initial
      1. Depakote ER 500 mg orally daily for 7 days
      2. Depakote delayed release 250 mg orally twice daily
    2. May increase to 1000 mg/day
  3. Bipolar Disorder
    1. Loading dose in acute mania: 15-20 mg/kg
    2. Starting dose without load: 500 to 750 mg/day in divided dosing
    3. Titrate every 2-3 days as tolerated to serum Valproic Acid level of 50 to 125 mcg/ml
    4. Target dose: 1000 to 3000 mg daily in divided doses

VII. Drug Interactions

  1. Numerous drug interactions

VIII. Toxicity

  1. Large therapeutic window

IX. Monitoring

  1. Serum Valproate level
    1. Initial: Every 1-2 weeks
    2. Later: Every 3-6 months
  2. Other routine monitoring
    1. Obtain monthly for 2 months and then every 3 to 12 months
    2. Complete Blood Count
    3. Liver Function Tests

X. Pregnancy Risk

  1. Class D

XI. History

  1. Synthesized in 1882, but not recognized as an anticonvulsant until 1963

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Cost: Medications

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