Therapeutic Action
Antiseizure (antiepileptic), mood stabilizer
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Drug reference
Antiseizure (antiepileptic), mood stabilizer
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Epilepsy: generalised tonic-clonic seizures, focal (partial) seizures and absence seizures Prevention of recurrence of bipolar disorder
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Do not administer: to women and girls of childbearing age. If the treatment is necessary and if there is no alternative, a negative blood pregnancy test and effective contraception are required; to children under 2 years (increased risk of hepatotoxicity); to patients with pancreatitis, hepatic disease or history of hepatic disease. Reduce dosage in patients with renal impairment. May cause: drowsiness (caution when driving/operating machinery), extrapyramidal symptoms, behavioural disturbances, confusional state, insomnia; weight gain, menstrual irregularities, gastrointestinal disturbances, vitamin D deficiency (consider supplementation), osteoporosis, thrombocytopenia; rarely: pancreatitis, hepatic disorders (e.g. elevated liver enzymes), prolonged bleeding time, hypersensitivity reactions (including severe cutaneous reactions such as Stevens-Johnson, Lyell and DRESS syndromes), hyperammonemic encephalopathy. In these cases, stop treatment. Early symptoms such as fever, rash, mouth ulcers and bleeding require immediate medical attention. respiratory depression and coma in the event of overdose. If possible, perform at least FBC, liver enzymes and serum sodium levels, at baseline then regularly during treatment; check prothrombin time before surgical procedures. Avoid or monitor the combination with: mefloquine, carbapenems, tricyclic antidepressants, rifampicin, protease inhibitors, other antiseizure medications (reduced effect of VPA); acetylsalicylic acid, erythromycin, isoniazid (increased VPA toxicity); drugs containing alcohol, benzodiazepines, opioid analgesics, antipsychotics, first-generation antihistamines (hydroxyzine, promethazine), antidepressants, other antiseizure medications, etc. (increased sedation). Avoid alcohol during treatment (increased risk of adverse effects). Pregnancy: do not use (risk of neural tube defects; urogenital, limb and facial malformations; neurodevelopmental disorders). In case of pregnancy during treatment, change to a safer drug (levetiracetam). If VPA is the only option, provide counselling about the risks to the child; use the lowest effective dose and divide doses over the day to minimize peaks in plasma concentrations. Administer folic acid high dose (5 mg daily) during the first trimester. Start as soon as possible, including during the preconception period in case of planned pregnancy. Breast-feeding: administer with caution (excreted in milk); monitor the child (risk of hepatotoxicity and bleeding).
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200 mg and 500 mg enteric-coated tablets 200 mg/5 ml oral solution, to be administered using a measuring device (oral syringe, measuring spoon, or cup with graduations).
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Start with a low dose then increase gradually based on patient's response and tolerance. Epilepsy Child 2 to 11 years: start with 10 to 15 mg/kg once daily or 5 to 7.5 mg/kg 2 times daily; increase the daily dose by increments of 5 to 10 mg/kg every week, up to 12.5 to 15 mg/kg 2 times daily if necessary (max. 600 mg 2 times daily). Child 12 years and over and adult: start with 500 to 600 mg once daily; increase the daily dose by increments of 200 mg every 3 days, up to 500 mg to 1 g 2 times daily if necessary (max. 2.5 g daily). Prevention of recurrence of bipolar disorder Adult: start with 200 mg 2 times daily; increase the daily dose until the optimal individual dose is reached, usually around 500 mg 2 times daily (max. 1g 2 times daily).
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As long as required. Do not stop treatment abruptly, even if changing treatment to another medication.
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Take with meals. VPA can be used with contraceptive implants and oral contraceptives, although estrogens may decrease VPA plasma concentrations.
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– – Below 25 °C
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start with 500 to 600 mg once daily; increase the daily dose by increments of 200 mg every 3 days, up to 500 mg to 1 g 2 times daily if necessary (max. 2.5 g daily).
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start with 200 mg 2 times daily; increase the daily dose until the optimal individual dose is reached, usually around 500 mg 2 times daily (max. 1g 2 times daily).
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