Valproate

Valproate

Have you ever wondered about a medication that can help control seizures and manage mood disorders? Valproate is a powerful and versatile medicine that effectively treats various neurological conditions. This medication, available as valproate tablets, has become a go-to option for many doctors due to its wide range of uses & proven track record.

In this article, we will explore the many facets of valproate. Readers will learn about its uses, how to take it properly, and what side effects to watch out for. We will also look into how valproate works in your body, its interactions with other medicines, and essential valproate dosage information. 

What is Valproate?

Valproate is a versatile medication that has gained recognition for its effectiveness in treating various neurological conditions. It is a branched-chain organic acid used to manage epilepsy, bipolar disorders, and migraine headaches. Valproate comes in different forms, including valproic acid and sodium valproate.

Valproate has been approved for use since 1978 and has become a go-to option for doctors due to its wide range of uses. Valproate is available as a tablet, either short-acting or long-acting, and as an intravenous solution.

Valproate Tablet Uses

Valproate tablets have a wide range of uses in treating neurological and psychiatric conditions, such as:

• As a single therapy and adjunctive therapy to treat complex partial seizures in adult and paediatric patients aged ten and older.
• Valproate tablets help to treat simple and complex absence seizures and multiple seizure types.
• Valproate can also treat and manage bipolar disorder, particularly during manic episodes. It helps to stabilise mood and manage symptoms of mania, such as frenzied or abnormally excited behaviour.
• Another vital use of valproate tablets is in preventing migraine headaches. However, it is important to note that valproate is not used to relieve headaches that have already begun.

In some cases, doctors may prescribe valproate for off-label uses, such as: 

• Diabetic peripheral neuropathy
• Postherpetic neuralgia
• Emergency treatment of status epilepticus
• Symptoms of impulsivity, agitation, and aggression

How to Use Valproate Tablets

To use valproate tablets properly, follow your doctor's instructions carefully, including:

• Individuals can take valproate with or without food, but it is best to stick to the same way each time. 
• Swallow the tablets whole with a drink of water or juice. Do not chew them. 
• Depending on the type of tablet, you will take them once or twice a day. If you are on a once-daily dose, choose a time that suits you and stick to it. Try to have an interval of 10 to 12 hours for twice-daily doses between them. 
• Your doctor will likely start you on a low dose and gradually increase it over time. It is essential to take valproate regularly and not miss doses, as this can trigger seizures in people with epilepsy.

Side Effects of valproate tablet

Valproate tablets can cause various side effects, ranging from mild to severe. Common side effects include: 

• Stomach pain
• Feeling sick
• Diarrhoea
• Headaches
• Drowsiness
• Weight changes
• Thinning hair
• Shaking in parts of the body or unusual eye movements

More serious side effects, although rare, can occur, including: 

• Thoughts of self-harm
• Depression
• Liver issues causing yellowing of the skin or eyes, severe stomach pain, and unusual bruising
• Serious allergic reactions, such as sudden swelling of the lips, mouth, or throat, difficulty breathing, or skin changes

In very rare cases, valproate can cause fatal brain disorders (encephalopathy), particularly in patients with certain metabolic disorders (urea cycle disorders). Symptoms may include severe vomiting, unexplained weakness, and sudden mental/mood changes.

Precautions

When taking valproate, you need to be aware of several essential precautions, such as: 

• Allergies: Before taking valproate, inform your doctor if you are allergic to it or other medicines. You should also tell your doctor about all your ongoing medicines, vitamins/minerals, and herbal supplements.
• Liver Ailments: It is necessary to inform your doctor about any liver problems, as valproate can cause liver failure, especially in children under two and those with certain genetic disorders. You should not use valproate if you have liver disease, a urea cycle disorder, or specific genetic conditions like Alpers' disease.
• Pregnancy: Pregnancy is a significant concern with valproate use. It can impact an unborn baby and may cause congenital disabilities, particularly during the first three months of pregnancy. Discuss this with your doctor if you are pregnant or planning to conceive. They may prescribe alternative medications or adjust your treatment plan.
• Monitoring: Regular check-ups and blood investigations are essential to monitor for any unwanted effects. Be alert for signs of liver or pancreas problems (loss of appetite, stomach pain, nausea, dark urine, or yellowing of the skin or eyes). If you experience these symptoms, try to contact your doctor urgently.

How Valproate Tablet Works

Valproate tablets work in several ways to control seizures and manage mood disorders. They increase gamma-aminobutyric acid (GABA) levels in the brain, render a calming effect and help reduce excessive electrical activity. This increase in GABA also contributes to valproate's effectiveness in treating bipolar disorder. 

Valproate also affects sodium channels, limiting the high-frequency firing of neurons. This action helps prevent seizures and stabilises mood. Additionally, valproate affects fatty acid metabolism, which may alter membrane fluidity and increase the threshold for action potentials.

Valproate's mechanism for migraine prevention has yet to be fully understood. However, it is thought to limit how nerves transmit pain signals in the brain. Valproate also has neuroprotective effects, preventing neural damage and degeneration in various conditions.

Can I Take Valproate with Other Medicines?

Some medicines that may interact with valproate include: 

• Alcohol
• Antidepressants like phenelzine
• Antiepileptic drugs like lamotrigine and phenobarbital
• Antibiotics such as imipenem
• Antihistamines like cetirizine, diphenhydramine
• Antiseizure medications, such as amitriptyline, carbamazepine, and lamotrigine 
• Drugs that inhibit UGT enzymes, such as aspirin and some nonsteroidal anti-inflammatory drugs (NSAIDs)
• Mefloquine
• Opioid pain relievers, such as codeine, hydrocodone
• Orlistat
• Rifampin
• Salicylates
• Sulfonamides
• Warfarin 
• zidovudine 

Always consult your physician or expert doctor before starting, stopping, or changing any medication while using valproate.

Dosing Information

Valproate dose requires careful adjustment based on blood levels to ensure a steady concentration within the therapeutic range. 

The initial dose for complex partial seizures is 10 to 15 mg/kg/day orally, with doses over 250 mg/day given in divided doses. 

For simple and complex absence seizures, the starting dose is usually 15 mg/kg/day orally. Doses are increased gradually, often by 5 to 10 mg/kg weekly, until seizures are controlled or side effects prevent further increases.

For migraine prevention, the usual dose is 250 mg twice daily, not exceeding 1000 mg/day. 

In bipolar mania, treatment often starts at 750 mg/day in divided doses, adjusting as needed up to 60 mg/kg/day.

The therapeutic range for epilepsy is 50-100 mcg/mL, while for mania it is 50-125 mcg/mL.

It is important to monitor liver function tests and valproate levels regularly. 

Conclusion

Valproate tablets have proven to be a versatile and effective medication for managing various neurological conditions. From controlling seizures to stabilising mood and preventing migraines, this drug has a significant impact on improving the quality of life for many patients. It is crucial to remember that while valproate can be highly beneficial, it also comes with potential side effects and necessary precautions that need careful consideration. Regular check-ups and blood tests ensure the medication works effectively and safely. Valproate remains an essential tool in the medical field, offering hope and relief to those struggling with epilepsy, bipolar disorder, and chronic migraines.

FAQs

1. What is the drug valproate used for?

Valproate is a versatile medication used to treat various neurological conditions. It is primarily prescribed for epilepsy to control different types of seizures. Valproate is also used to manage bipolar disorder, particularly during manic episodes. Additionally, it is effective in preventing migraine headaches, though it does not relieve headaches that have already begun.

2. Who should not take valproate?

Valproate is not suitable for everyone. People with liver disease, urea cycle disorders, or certain genetic conditions like Alpers' disease should avoid it. It is also not recommended for pregnant women or those aspiring for the same, as it can cause serious congenital disabilities. If you have a history of liver problems or pancreatic issues, you should discuss this with your doctor before taking valproate.

3. Does valproate make you sleepy?

Valproate can cause drowsiness in some people. This side effect is often more noticeable when you first start the medicine or when the dose is increased. If you experience excessive sleepiness, talking to your doctor is essential. Remember not to drive or operate machinery until you know how valproate affects you.

4. Does valproate cause kidney damage?

While valproate is not associated with kidney damage, some studies have suggested it may cause a paucisymptomatic kidney tubular injury in some cases. This is more likely to occur after prolonged use of the medication, typically seven months or more. If you are taking valproate, your doctor may monitor your kidney function during regular check-ups.

5. Can I stop taking valproate?

Never stop taking valproate suddenly without consulting your doctor. Abruptly stopping the medication can trigger severe, long-lasting, and life-threatening seizures. If you want to stop taking valproate, your doctor will create a plan to gradually reduce your dose over time. This process, known as tapering, helps minimise withdrawal symptoms and reduce the risk of seizures.

6. Does valproate reduce anxiety?

While doctors primarily do not prescribe valproate for anxiety, some studies suggest it may have anxiolytic (anxiety-reducing) properties. If you are experiencing anxiety, it is best to discuss specific treatment options with your doctor.