Sodium Valproate (Epilim Depakote)

Related Subjects: | Status Epilepticus (Epilepsy) | Coma management | Lorazepam | Phenytoin | Levetiracetam | Epilepsy - General Management | First Seizure | Epilepsy in Pregnancy | Febrile seizures

About : Always check the BNF link here

• Useful general purpose Anticonvulsant
• Migraine prophylaxis and Mood stabiliser

Mode of action

• Blocks Na⁺ channels, Inhibits GABA transaminase
• VPA is a histone deacetylase inhibitor so may have additional uses e.g. in HIV disease

Indications

• First choice in all types of seizure, Idiopathic generalised epilepsy
• Useful in most forms of epilepsy, Mania and psychiatric disorders

Indication/Dose range: See BNF link above

Monitoring

• Monitor LFTs for first 6 months
• Trough Valproate 350-700 micromol/L (50-100 mg/L)
• Toxic Valproate 1260 micromol/L (>180 mg/L)
• Check platelets/coagulation with any suggestion of bleeding

Contraindications

• Liver disease or family history of liver disease, Porphyria
• Consider Haemodialysis for toxicity
• Concerns over Teratogenicity. Avoid in Women of childbearing potential, unless the conditions of the Pregnancy Prevention Programme are fulfilled (https://www.gov.uk/guidance/valproate-use-by-women-and-girls)
• Severe liver failure, Mitochondrial disorders

Side effects

• Nausea, Vomiting, anorexia, Acute pancreatitis
• Increased appetite, Weight gain, Parkinsonism
• Hair loss, tremor, Cerebellar signs, Sedation
• Thrombocytopenia, Hyperammonaemia (especially if mitochondrial disease)
• Teratogenicity - ensure adequate advice and contraception
• False positive urine dipstick for ketones, DRESS, TEN, SJS

Interactions

• Isoniazid can raise valproate levels
• For patients already on lamotrigine, dose reduction will be required when starting regular sodium valproate. On reducing lamotrigine dosing please seek advice from neurology and/or pharmacy.

References

• Valproate in BNF
• NHS guidance for Status Epilepticus Cornwall