Valproate

Question 1

Valproate
Brand Name

Answer 1

Depakote (ER, Sprinkles)
Depacon
Depakene

Question 2

Valproate
OTHER GENERIC NAMES

Answer 2

valproate sodium
divalproex sodium
valproic acid

Question 3

Valproate
Formulations

Answer 3

IR capsule: 250mg
Delayed-release sprinkle capsule: 125mg
IR solution: 250mg/5mL
IV solution: 100mg/mL
Delayed-release tablet: 125mg, 250mg, 500mg
ER tablet: 250mg, 500mg

Question 4

Valproate
On-Label Indications

Answer 4

Bipolar disorder-
Acute mania:
-with or without mixed features
-with or without psychotic features
Seizures
Migraine prevention

Question 5

Valproate
Off-Label Indications

Answer 5

Bipolar maintenance treatment: prevention of mania
Rapid cycling bipolar disorder
Bipolar depression (minor efficacy)

Question 6

Valproate
MOA

Answer 6

Uncertain;
Increased GABA action
Inhibits VSSCs

Question 7

Valproate
CYP450 Pathway

Answer 7

Unclear-
CYP2C9 inhibitor?
Lowers Lithium levels

Question 8

Valproate
Dose Range (Adult)

Answer 8

Weight-based dosing
20-60mg/kg/day in 1-4 divided doses

Question 9

Valproate
Titration

Answer 9

Adjust up or down to desired clinical effect
Reference serum concentration

Question 10

Valproate
Tapering

Answer 10

DO NOT stop abruptly, can induce seizures

Question 11

Valproate
Dosing (Kidney Impairment)

Answer 11

No specific adjustment needed, monitor clinical response

Question 12

Valproate
Dosing (Liver Impairment)

Answer 12

Mild-moderate impairment: not recommended
Severe impairment: contraindicated

Question 13

Valproate
Dosing (Elderly)

Answer 13

Start 125-250mg/day in 1-4 doses
Incr by 125-250mg Q2-5d
More sensitive to sedation and dehydration

Question 14

Valproate
OB

Answer 14

HIGHLY TERATOGENIC!!

Question 15

Valproate
Side Effects

Answer 15

Amenorrhea, possibly PCOS
GI upset, weight gain
Hepatotoxic: elevated ammonia levels
Thrombocytopenia

Question 16

Valproate
Contraindications

Answer 16

Pregnancy
Lactation
Liver impairment

Question 17

Valproate
Interactions
Increases concentration of:

Answer 17

diazepam, lamotrigine, TCAs, warfarin
-requires dose adjustment & caution
Decreases lithium levels

Question 18

Valproate
Interaction w/ topiramate

Answer 18

Topiramate (Topamax): incr. risk hyperammonemia & encephalopathy

Question 19

Valproate
Monitored at 2 weeks, 4 weeks, 3 months, then Q6months:

Answer 19

CMP (liver enzymes)
CBC
Glucose
Weight

Question 20

Valproate
Monitored Q6months, with change in dose/clinical status:

Answer 20

CMP
CBC
Serum levels
Lipid panel

Question 21

Valproate
Therapeutic Drug Levels

Answer 21

50-125mcg/L

Question 22

Valproate
Toxicity s/s

Answer 22

Irregular heartbeat
CNS depression, respiratory depression
N/V
Myoclonus (involuntary twitching)

Question 23

Valproate
Pearls

Answer 23

Avoid use w/ alcoholism
Not best choice for child-baring individuals
-confirm birth control methods, negative HcG
“Good for irritability”
MINOR efficacy for depression
Med works very fast for mania