Dr C P Ravikumar

Sodium Valproate

cpravikumar
sodium valproate

Dr. C P Ravi Kumar

SODIUM VALPROATE:

It is an Anti-seizure drug used to control seizures

Uses of sodium valproate

  1. Epilepsy
  2. Migraine
  3. Mood disorder / Bipolar disorder

How is sodium valproate available?

  1. Syrup
  2. Extended-release (long-acting) tablet
  3. Delayed-release tablet (releases the medication in the intestine to prevent damage to the stomach)
  4. Sprinkle capsule (capsule that contains small beads of medication that can be sprinkled on food); not available in India as of yet

Are sodium valproate and valproic acid the same?

Valproate sodium, Valproic acid and Divalproex sodium are all similar medications that are used by the body as valproic acid. Therefore, the term valproic acid will be used to represent all of these medications in this discussion.
They are absorbed by the body in different ways and cannot be substituted for one another. If you need to switch from one product to another, your doctor may need to adjust your dose.

How does sodium valproate act?

It acts by reducing the abnormal excitatory action of the nerve cells and thereby reduces the frequency of seizures.

Why is sodium valproate important for your child’s treatment?

It is important that your child takes sodium valproate regularly so that they have no Seizures or fewer seizures.

When should sodium valproate be taken?

Sodium valproate can be taken with or without food, but follow the same on each day If taking twice a day, leave a gap of 10-12 hours between the doses. It is recommended to give the medication at the same time each day to help establish a routine and minimize the risk of forgetting a dose.

How should I take the medicine?

The syrup, delayed-release tablets, and sprinkle capsules are usually taken two or more times daily. The extended-release tablets are usually taken once a day.
It can be taken before food or after food
Tablets: Swallow a whole tablet with a glass of water, juice, or milk. Alternatively, you can crush the tablet and mix it with water, juice, or a small serving of yogurt or curd before giving it.
Liquid or syrup: Measure the correct dose using an oral syringe or a medicine spoon, which you can easily find at a nearby pharmacy. Avoid using a kitchen teaspoon, as it does not provide accurate measurements.

What if I miss a dose?

If you miss the dose, it can be taken as soon as you remember within the lapse of 6 hours. Do not take the missed dose if it is close to the next one; just take the next dose as normal. If you miss two or more doses, discuss with your doctor.

NEVER DOUBLE DOSE SODIUM VALPROATE.

How much of the drug should be taken?

Your doctor will work out the accurate amount of sodium valproate for your child in the prescription. Usually prescription begins with a small dose and dose gradually increases over days or weeks to help their body adjust with the medication.
Your doctor will provide guidance on the specific steps to follow.

Warning / Caution:

Every medication has both positive and potential negative effects. Fortunately, adverse effects are not common for everyone, but it’s essential to be aware of them. Understanding possible side effects allows us to act quickly and effectively if they occur, ensuring that we can address any concerns promptly while continuing to benefit from the intended effects of medications.
Even though it may be rare, few people sometimes may have serious side effects when taking a drug. Consult your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect:
  • Liver problems like dark urine, tiredness, decreased appetite, upset stomach or stomach pain, light-colored stools, throwing up, or yellow skin or eyes
  • Symptoms of pancreatitis such as stomach pain, upset stomach, throwing up or decreased appetite
  • High ammonia levels
  • Change in balance / Shakiness / Trouble walking
  • Any unexplained bruising or bleeding
  • Muscle pain or weakness
  • Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing, swallowing, or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat; Purple spots or redness of the skin

Alert:

  1. Hepatotoxicity – Serious effects are rare, usually in the first 6 months of treatment. Serum liver function tests can be monitored at regular intervals.
  2. Patients with mitochondrial disease: If known to have mitochondrial disorder, then avoid valproate. If the underlying disease is unknown, then it can trigger serious liver failure.
  3. Fetal risk: Can cause major malformation in an unborn baby, hence avoided.
  4. Pancreatitis: Can cause life-threatening pancreatitis.
All drugs may cause side effects. However, many people have no side effects or only have minor side effects. Call your doctor or get medical help if any of these side effects or any other side effects bother you or do not go away:

Side Effects:

Source: LEXICOMP.
>10%: Common ones
  • Skin related (Dermatologic): Hair loss
  • Gastrointestinal: Abdominal pain, fear of gaining weight (anorexia), indigestion, nausea, vomiting
  • Blood related (Hematologic): Reduced platelet counts (Thrombocytopenia)
  • Nervous system: Tiredness, dizziness, drowsiness, headache, oversleep (insomnia), nervousness, tremors
  • Eye related (Ophthalmic): Double vision (Diplopia)

1% to 10%: Less common
  • Skin related (Dermatologic): Erythema multiforme, Toxic epidermal necrosis, Steven Johnson syndrome, photosensitivity
  • Hormonal (Endocrine & metabolic): Absence of menses (Amenorrhea), weight gain, PCOD
  • Gastrointestinal: Constipation, flatulence, gastroenteritis, bleeding gums, blood in vomit (hematemesis), increased appetite, pancreatitis, dry mouth
  • Blood related (Hematologic & oncologic): Anaemia, reduced sodium level, leukopenia, small red or purple spots on skin (petechia), prolonged bleeding time
  • Liver related (Hepatic): Increased liver enzymes
  • Hypersensitivity/ intolerance: Facial swelling
  • Nervous system: Abnormal walk, anxiety, impaired co-ordination, behavioural syndrome (catatonia), confusion, depression, personality disorder
  • Neuromuscular & skeletal: Joint pain, back pain, discoid lupus erythematosus, reduced muscle movement, lower limb cramp, muscle pain, osteoarthritis
  • Eye related (Ophthalmic): Conjunctivitis, dry eye syndrome, involuntary eye movements (nystagmus), light intolerance (photophobia)

Can I stop taking sodium valproate?

Antiseizure medications should not be discontinued abruptly because of the possibility of increasing seizure frequency; therapy should be withdrawn gradually to minimize the potential of increased seizure frequency, unless safety concerns require a more rapid withdrawal.

Can other common medicines be taken during the course of sodium valproate?

Always consult your doctor before taking any other medications, including herbal or complementary treatments.
Certain medications used to treat epilepsy such as lamotrigine may interfere with the effectiveness of sodium valproate or lead to unwanted side effects. If you have more seizures or experience other side effects after starting new medications, contact your doctor right away.
Medications such as ibuprofen, paracetamol, antibiotics, and other over-the-counter drugs can be used when needed, UNLESS your doctor has specifically restricted.

What foods or medications should I avoid while using this medication?

Alcohol: Alcohol can increase the sedative effects of sodium valproate and may impair liver function, which is crucial for metabolizing the drug.
Recommendation: Avoid or minimize alcohol consumption.

Carbonated Drinks: Carbonated beverages may increase the acidity in the stomach, potentially affecting the drug’s absorption or causing irritation. Recommendation: Limit consumption of fizzy drinks.

Herbal Supplements and Stimulants: Some herbal products and caffeine-rich foods or drinks may interfere with medication effects. Recommendation: Consult your healthcare provider before consuming herbal supplements.

Foods That May Affect Liver Function
Sodium valproate is metabolized in the liver, so any food that stresses the liver (like excessive sugar, saturated fats, or fried foods) could worsen side effects.
Recommendation: Prioritize liver-friendly foods like fruits, vegetables, whole grains, and lean protein.

Additional Tips:

  • Stay hydrated to help your body process the medication efficiently
  • Ensure your diet includes sufficient folate and vitamin D, as sodium valproate may deplete these nutrients over time

Valproate in Women

  • Avoid in childbearing age
  • Contraindicated in pregnancy, unless no other drug can control seizure
  • Where possible, avoid in all girls as it has a high risk of causing PCOD

Effects of Valproate on OCPs:

generally no significant effect, it is best to discuss with your physician and clarify.

Effects of OCPs on Valproate:

OCP can lowers valproate levels: Estrogen-containing OCPs may increase the metabolism of valproate, potentially leading to lower serum valproate levels. This can reduce its therapeutic effect and potentially increase the risk of seizures in individuals with epilepsy. Please discuss with your doctor.

Pregnancy and Lactation

Avoid, unless no other drugs are effective. Best is to discuss with the concerned doctor.

AVOID IN PATIENTS WITH MITOCHONDRIAL DISEASE

Monitoring Parameters:

  • Serum ammonia level
  • Liver function tests
  • CBC, Prothrombin time
  • Monitor for depression, suicidal ideation

When to get tested for Drug level monitoring:

  • Medication residue in stool
  • Seizure not well controlled

How to cope with side effects of sodium valproate?

  • Stomach pain, feeling or being sick: Avoid spicy food. Take small, frequent sips of water to avoid dehydration. Taking a tablet with food is advisable.
  • Diarrhea: Drink plenty of fluids
  • Dry mouth or swollen gums: For dry mouth, try sipping water or cold drinks regularly. If you experience symptoms of swollen gums, talk to the doctor.
  • May feel sleepy or dizzy, so avoid machinery work and driving.
  • Weight gain: Try to eat a balanced diet and limit portion sizes. Physical activity can help with weight gain and improve mental health.
In summary, Sodium valproate is a widely used anti-seizure medication that offers significant benefits in managing epilepsy, migraines, and mood disorders. Its ability to stabilize nerve cell activity helps reduce the frequency of seizures and improve quality of life. Available in various forms, it suits diverse patient needs and dosing routines. While like any medication, it carries some risks, including potential liver issues or weight gain, serious side effects are rare and manageable with regular monitoring and proper guidance from a doctor. With adherence to prescribed doses and lifestyle adjustments, the advantages of sodium valproate far outweigh its drawbacks, ensuring effective and safe treatment.
Author:
1. Dr Praveen Kumar, B.Pharm,Pharm D(PB), Head Clinical Pharmacologist, Aster Hospitals, Bengaluru
2. Dr. Ramya. R, Pharm D, Clinical pharmacologist, Aster Hospitals, Bengaluru
3. Dr C P Ravi Kumar, Consultant Paediatric Neurologist, Aster CMI Hospital
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