SODIUM VALPROATE

Valproate ( Depakene, Depakote) is used

to treat bipolar I disorder & is equal in
efficacy & safety to lithium . Valproate is
also used in treatment of schizoaffective
disorders, impulse control disorders &
behavioural agitation. Valproate is an
effective prophylaxis against migraine
headaches.

INTRODUCTION
Available formulations include valproic
acid (Depakene); divalproex ,a 1:1
mixture of valproic acid & sodium
valproate. Valproate is also called
valproic acid because it is rapidly
converted to the acid forms in the
stomach.

CHEMISTRY
All valproate formulations are rapidly &
completely absorbed after the oral
administration .The steady half life of valproate
is about 8-17 hours,& clinically effective
plasma concentrations can be usually be
maintained with dosing one to four times a
day. Protien binding becomes saturated &
concentrations of therapeutically effective free
valproate increase at serum concentrations
above 50-100 ug/mL.

PHARMACOLOGICAL ACTION

The therapeutic effects of valproate in
bipolar I disorder may be mediated by as
yet undefined effects of the drug on
gamma aminobutyric acid neurotransmitter
system.

CONTD.
Bipolar I disorder

Schizoaffective disorder

Other mental disorder-It is effective for the
treatment of intermittent explosive disorder,
kleptomania,& other behavioural dyscontrol
syndromes, particularly if these disorders are
comorbid with bipolar symptoms..


THERAPEUTIC INDICATIONS

Valproate can effectively control physical
aggression, restlessness, agitation,& to a
lesser degree, verbal aggression
associated with dementia ,organic brain
disease or traumatic brain injury
CONTD.
Pregnancy
Lactating mothers
Bleeding disorders
Hepatic disorders
Renal diseases

CONTRAINDICATIONS

Valproic acid produces false positive
results for urine ketones, elevated
AST, ALT, LDH , serum alkaline
phosphatase, prolonged bleeding time,
altered thyroid time.

DIAGNOSTIC TEST INTERFERENCE
CNS-Seizures,increased
alertness,hallucinations,aggression,sedation,
GI- Nausea ,vomiting, indigestion , hyper
salivation ,anorexia with weight loss, abdominal
cramps with diarrhoea, hepatic failure.
Hematolgical-Prolonged bleeding time ,
leukopenia, thrombocytopenia ,bone marrow
depression & anemia.
Other-Skin rashes, transient hair loss, irregular
menses, secondary ammenhorea
Overdose-Deep coma ,pulmonary edema,death

ADVERSE EFFECTS

ADMINISTRATION

Tablets & capsules should not be chewed. It should be
swallowed the whole.

To reduce gastric irritation administer drug with food
.Enteric coated tablets or syrup is well tolerated.

Abrupt discontinuation of the drug can lead to loss of
seizure control. Warn the patient not to stop or alter the
treatment regimen without consultation.


NURSING IMPLICATIONS


Therapeutic effectiveness is indicated by
decrease in BP.

Periodically monitor liver functions,BUN &
creatinine,serum potassium,CBC.


ASSESSMENT


oWomen who become pregnant should
immediately inform their physicians.

oWeight gain is a common side effect
especially in long term treatment & can be
treated by limited calorie intake.

oThe risk of valproate induced neural tube
defects can be reduced by administration of
folic acid supplements.



PATIENT TEACHING

THANK U