Valproate: Difference between revisions
No edit summary |
No edit summary |
||
Line 5: | Line 5: | ||
==Adult Dosing== | ==Adult Dosing== | ||
===[[Seizures]]=== | |||
* Oral (max 60mg/kg/d) | |||
** Simple/complex absence: Initial 15mg/kg/d; increase 5-10mg/kg/d at weekly until therapeutic | |||
** Complex partial: Initial 10-15mg/kg/d; increase 5-10mg/kg/d at weekly until therapeutic | |||
*** Extended release formulation given once daily | |||
*IV: same dose as oral, administered as 60min infusion | |||
===[[Status epilepticus]], refractory=== | |||
*IV: Loading 15-20mg/kg administered at 20mg/min | |||
**Maintenance: 1-5mg/kg/hr | |||
===[[Mania]]=== | |||
*Oral: Depakote Stavzor 750mg/d or Depakote ER 25mg/kg/d qday | |||
===[[Migraine]] prophlyaxis=== | |||
* Oral: Depakote, Stavzor 250mg BID or Depakote ER 500mg qday | |||
==Pediatric Dosing== | ==Pediatric Dosing== | ||
*Same as adult dosing | *Same as adult dosing | ||
*Avoid extended release formulation in children <10yr | *Avoid extended release formulation in children <10yr | ||
==Special Populations== | ==Special Populations== | ||
*[[Drug Ratings in Pregnancy|Pregnancy Rating]]: X | *[[Drug Ratings in Pregnancy|Pregnancy Rating]]: X | ||
Line 32: | Line 37: | ||
*Allergy to class/drug | *Allergy to class/drug | ||
*Severe hepatic impairment | *Severe hepatic impairment | ||
*Pregnancy | *[[Pregnancy]] | ||
*Urea cycle disorders | *Urea cycle disorders | ||
*Mitochondrial disorders | *Mitochondrial disorders | ||
==Adverse Reactions== | ==Adverse Reactions== | ||
===Serious=== | ===Serious=== | ||
Line 40: | Line 46: | ||
*Congenital malformation: neural tube defect | *Congenital malformation: neural tube defect | ||
*Pancreatitis | *Pancreatitis | ||
===Common=== | ===Common=== | ||
*Headache, drowsiness, dizziness, insomnia, nervousness, pain | *[[Headache]], drowsiness, dizziness, insomnia, nervousness, pain | ||
*Alopecia | *[[Alopecia]] | ||
*Nausea, vomiting, diarrhea, abdominal pain, anorexia | *[[Nausea]], [[vomiting]], [[diarrhea]], [[abdominal pain]], [[anorexia]] | ||
*Thrombocytopenia | *[[Thrombocytopenia]] | ||
*Infection | *Infection | ||
*Tremor, weakness | *[[Tremor]], [[weakness]] | ||
*Diplopia, visual disturbance | *[[Diplopia]], visual disturbance | ||
*Flu-like symptoms | *[[Flu-like symptoms]] | ||
==Toxicity== | ==Toxicity== | ||
Line 65: | Line 72: | ||
*[[Seizure]] | *[[Seizure]] | ||
== | ==References== | ||
<references/> | |||
[[Category:Drugs]] | [[Category:Drugs]] |
Revision as of 15:39, 14 September 2015
General
- Type: Anticonvulsants
- Dosage Forms: 125mg; 250mg; 500mg; 100mg/mL; 250mg/5mL; 500mg/5mL
- Common Trade Names: Depacon, Depakene, Depakote, Depakote ER. Depakote Sprinkles, Stavzor
Adult Dosing
Seizures
- Oral (max 60mg/kg/d)
- Simple/complex absence: Initial 15mg/kg/d; increase 5-10mg/kg/d at weekly until therapeutic
- Complex partial: Initial 10-15mg/kg/d; increase 5-10mg/kg/d at weekly until therapeutic
- Extended release formulation given once daily
- IV: same dose as oral, administered as 60min infusion
Status epilepticus, refractory
- IV: Loading 15-20mg/kg administered at 20mg/min
- Maintenance: 1-5mg/kg/hr
Mania
- Oral: Depakote Stavzor 750mg/d or Depakote ER 25mg/kg/d qday
Migraine prophlyaxis
- Oral: Depakote, Stavzor 250mg BID or Depakote ER 500mg qday
Pediatric Dosing
- Same as adult dosing
- Avoid extended release formulation in children <10yr
Special Populations
- Pregnancy Rating: X
- Lactation: Use with caution. Excreted in breast milk.
- Renal Dosing: No adjustment
- Hepatic Dosing
- Mild-mod impairment: Not recommended
- Severe impairment: Contraindicated
Contraindications
- Allergy to class/drug
- Severe hepatic impairment
- Pregnancy
- Urea cycle disorders
- Mitochondrial disorders
Adverse Reactions
Serious
- Hepatotoxicity
- Congenital malformation: neural tube defect
- Pancreatitis
Common
- Headache, drowsiness, dizziness, insomnia, nervousness, pain
- Alopecia
- Nausea, vomiting, diarrhea, abdominal pain, anorexia
- Thrombocytopenia
- Infection
- Tremor, weakness
- Diplopia, visual disturbance
- Flu-like symptoms
Toxicity
- Potential use for early IV L-carnitine to reduce hepatotoxicity
- 100 mg/kg IV once, followed by 50 mg/kg (max 3 g per dose) q8hrs until ammonia levels normalize[1]
Pharmacology
- Half-life:
- Children >2mo: 7-13 hours
- Adult: 9-19 hours
- Metabolism: Hepatic glucuronide conjugation and mitochondrial beta-oxidation
- Excretion: Urine
- Mechanism of Action: Increases availability and enhances action of GABA
See Also
References
- ↑ Perott J et al. L-carnitine for acute valproic acid overdose: a systematic review of published cases. Ann Pharmacother. 2010 Jul-Aug;44(7-8):1287-93. doi: 10.1345/aph.1P135. Epub 2010 Jun 29.