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DRUGS Class and Mechanism: valproic acid and its derivative, divalproex, are oral drugs that are used to treat seizures, migraines and bipolar disorder. The active ingredient in both products is valproic acid or valproate. Scientists do not know the mechanism of action of valproate. The most popular theory is that valproate exerts its effects by increasing the concentration of gamma-aminobutyric acid (GABA) in the brain. The gamma-aminobutyric acid is a neurotransmitter, a chemical that nerves use to communicate with one another.
PRESCRIPTION: yes
Generic available: yes (valproic acid and divalproex)
PREPARATIONS: Depakote delayed release tablets: 125, 250 and 500 mg. Depakote Sprinkle capsules: 125 mg. Depakote ER 500 mg tablets. Depakene Capsules: 250 mg. Depakene syrup: 250 mg / 5 ml. Depacon (valproate sodium) injection: 100 mg / 5 ml. valproic acid capsules: 250 mg. valproic acid syrup 250 mg/5ml
STORAGE: Store at room temperature, 15-30 C (59-86 F).
Hint: Valproic acid and divalproex are used to treat seizures, bipolar disorder and migraine prevention. Depakote Extended Release (ER) is used 1) for migraine prevention 2) as adjunctive therapy for sole and complex partial seizures in isolation or in combination with other types of seizures and simple and crises complex absent in children 10 years and epilepsy above 3) for the treatment of acute manic or mixed episodes associated with bipolar disorder.
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Dosage: For seizures, treatment is initiated at 10-15 mg / kg / day and increased by 5-10 mg / kg / day each week to get the desired response. Response is usually seen when blood levels of valproic acid is 50-100 mcg / mL.
For acute mania due to bipolar disorder, treatment is started at 750 mg / day of divalproex delayed-release tablets in divided doses. The dose should be increased quickly to get the desired effect. The maximum dose is 60 mg / kg / day.
The recommended dose for migraine prevention is 250 mg twice daily delayed-release tablets of divalproex. The maximum recommended dose is 1,000 mg / day. When using divalproex ER tablets, the recommended dose is 500-1000 mg once per day.
INTERACTIONS: Valproic acid and divalproex have many suspects or known drug interactions. Although drug interactions are referenced to valproic acid, similar interactions may also occur with divalproex.
Valproic acid can reduce the number of platelets or impair the ability of platelets to clump together and form a blood clot. Therefore, it can exaggerate the effects of other drugs that inhibit platelet adhesion or inhibit other steps in the coagulation of blood. This can lead to abnormal bleeding due to the inability of blood to clot. These medications include warfarin (Coumadin), heparin or low molecular weight heparin (Lovenox), clopidogrel (Plavix), ticlopidine (Ticlid), and anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin, Advil), naproxen (Naprosyn, Aleve), indomethacin (Indocin), nabumetone (Relafen), diclofenac (Voltaren, Cataflam, Arthrotec), ketorolac (Toradol) and aspirin.
Aspirin and felbamate (Felbatol) may reduce the elimination of valproic acid and lead to high blood concentrations of valproic acid.
Rifampicin (Rifadin, Rimactane), carbamazepine (Tegretol), phenytoin (Dilantin) may increase the elimination of the valley.
Posted on March 3, 2010.
