VALPROIC ACID
(Depakene, Depakote)

Indication: Valproic acid is useful in treating absence seizure (petit mal), myoclonic epilepsy, and primary generalized epilipsy (grand mal). It is also helpful as an add-on therapy in patients with multiple seizure types that include absence seizures.

Possible side effects: There may be a decrease of appetite with nausea and vomiting when beginning on the drug. Depakote is the same drug as Depakene but made differently to avoid this problem. Dizziness, tremor, imbalance, and sedation may occur especially when valproic acid is used in conjunction with other drugs. This can be relieved by adjusting the dose. Increased appetite with weight gain and hair thinning are reported in some cases. More serious problems include liver damage and bleeding and/or bruising. If either of these becomes serious, it usually is reversed with discontinuation of the drug.

You need to be aware that with any changes in your anticonvulsant therapy, there may be an increase in seizure frequency. Keep in mind that side effects vary among individuals. If you have any problem with medication, you should let your doctor know, whether or not it is a problem listed above.

Dosage: Depakote comes in three strengths 125 mg (red), 250 mg (orange), and 500 mg (pink) tablets. Also available is the 125 mg sprinkle that can be opened and sprinkled on food for easier digestion. Depakene comes in 250 mg (red) capsules. Doses are regulated according to weight, effectiveness, blood levels, and side effects. For an adult of average weight as much as 3 Gms can be well tolerated and some patients use higher amounts. It should be taken with food to reduce digestive problems.

Drug interactions: Aspirin, chlorpromazine, cimetidine, erythromycin and Felbamate may increase valproic acid levels causing toxicity. Adding Lamotrigine to valproic acid can result in increased lamotrigene levels and decreased valproic acid levels. Adding phenobarbital can result in increased phenobarbital levels. Adding phenytoin or Rifampin (rifampicin) can result in decreased valproic acid levels. Valproic acid may displace Warfarin from binding sites on plasma proteins. This can result initially in higher levels, but levels can decrease because the warfarin is more quickly broken down by the liver. Other drugs can affect, or be affected by valproic acid.

Blood levels: The usual blood levels for valproic acid range between 50 and 150 ug/ml. However, some patients do well with lower levels and other patients have better seizure control with levels above 150 ug/ml. If you are not having side effects and are still having seizures, your doctor may consider using doses which result in higher blood levels.