PRIMARY GENERALISED SEIZURES E.G. ABSENCE AND MYOCLONIC SEIZURES
Adult:
Initially, 10-15 mg/kg/day in 2-4 divided doses, if necessary, increase at 5-10 mg/kg/wk.
Max Dosage: 60 mg/kg/day.
Oral
PRIMARY GENERALISED SEIZURES E.G. ABSENCE AND MYOCLONIC SEIZURES
Child:
≥10 yr: Initially, 10-15 mg/kg/day in 2-4 divided doses, if necessary, increase at 5-10 mg/kg/wk. Max: 60 mg/kg/day.
Max Dosage: 60 mg/kg/day.
Oral
PARTIAL SEIZURES
Adult:
Initially, 10-15 mg/kg/day in 2-4 divided doses, if necessary, increase at 5-10 mg/kg/wk. Max: 60 mg/kg/day.
Max Dosage: 60 mg/kg/day.
Oral
PARTIAL SEIZURES
Child:
≥10 yr: Initially, 10-15 mg/kg/day in 2-4 divided doses, if necessary, increase at 5-10 mg/kg/wk. Max: 60 mg/kg/day.
Max Dosage: 60 mg/kg/day.
Oral
ACUTE MANIAC EPISODES OF BIPOLAR DISORDER
Adult:
Initially, 25 mg/kg once daily, may increase rapidly to achieve optimal response at the lowest therapeutic dose. Max: 60 mg/kg/day.
Max Dosage: 60 mg/kg/day.
Oral
PROPHYLAXIS OF MIGRAINE
Adult:
500 mg once daily for 1 wk, may increase to 1000 mg once daily
Administration
Should be taken with food.
Precautions
Children <2 yr; congenital metabolic disorders; organic brain disease or severe seizure disorders; HIV infection; renal impairment; lactation. Monitor liver function before and during the 1st 6 mth of therapy. Monitor platelet function, signs of pancreatitis and SLE. Gradual withdrawal of valproate. May impair ability to drive or operate machinery. Increased risk of hyperammonemic encephalopathy in patients with urea cycle disorders.
Potentially Life-threatening
Adverse Drug Reactions
Behavioural/mood changes; hyperammonaemia; pancreatitis, thrombocytopenia. Abdominal cramps, anorexia, diarrhoea, hair loss, indigestion, nausea and vomiting; tremor; unusual weight loss or gain.
Adverse Drug Reactions
Hepatic failure, pancreatitis.
Interactions
Potentiates action of CNS depressants (barbiturates, primidone) and alcohol.
Felbamate increases valproate levels. Phenytoin, phenobarbitone and carbamazepine lower valproate levels. Increased risk of hepatotoxity with hepatotoxic drugs.
Food may delay the extent of absorption. Divalproex may cause GI upset; take with large amount of water of food to decrease GI upset.
