Home Drug Guide Valproate Sodium

Drug Guide

Generic Name

Valproate Sodium

Brand Names Depacon

Classification

Therapeutic: Anticonvulsant, Mood Stabilizer

Pharmacological: GABAergic agent

FDA Approved Indications

  • Prevention and treatment of seizures (including generalized seizures, complex partial seizures, absence seizures)
  • Manic episodes associated with bipolar disorder

Mechanism of Action

Valproate increases brain gamma-aminobutyric acid (GABA) levels by inhibiting GABA transaminase and succinate semialdehyde dehydrogenase, leading to enhanced inhibitory neurotransmission.

Dosage and Administration

Adult: Doses vary; initial doses around 600 mg/day divided in multiple doses, titrated up based on response and tolerability.

Pediatric: Dose depends on weight and age; typically starting at 10-15 mg/kg/day, adjusted as needed.

Geriatric: Careful dose titration due to increased risk of side effects.

Renal Impairment: Use with caution; monitor plasma levels, dose adjustments may be necessary.

Hepatic Impairment: Contraindicated in hepatic disease; use caution and monitor liver function during therapy.

Pharmacokinetics

Absorption: Rapid and complete when given orally.

Distribution: Widely distributed; crosses blood-brain barrier.

Metabolism: Metabolized in the liver via glucuronidation and beta-oxidation.

Excretion: Excreted primarily in urine as metabolites.

Half Life: Approximately 9-16 hours in adults; may be longer in children.

Contraindications

  • History of hypersensitivity to valproate or other valproic acid derivatives.
  • Hepatic disease.

Precautions

  • Monitor liver function regularly, especially during the first 6 months of therapy.
  • Use with caution in patients with mitochondrial disorders, bleeding disorders, or on other hepatotoxic drugs.
  • Pregnancy category D; risk of neural tube defects and developmental issues.

Adverse Reactions - Common

  • Gastrointestinal disturbances (nausea, vomiting) (Common)
  • Drowsiness, dizziness (Common)
  • Weight gain (Common)
  • Tremor (Common)

Adverse Reactions - Serious

  • Hepatotoxicity (liver failure) (Rare but serious)
  • Pancreatitis (Rare)
  • Thrombocytopenia, leukopenia, anemia (Rare)
  • Neural tube defects in pregnancy (Serious risk; contraindicated in pregnancy unless benefits outweigh risks.)

Drug-Drug Interactions

  • Carbapenem antibiotics (may decrease valproate levels)
  • Other CNS depressants (potential additive sedation)
  • Enzyme-inducing agents (may decrease valproate levels)

Drug-Food Interactions

  • None significant

Drug-Herb Interactions

  • None well documented

Nursing Implications

Assessment: Monitor liver function tests, complete blood counts, serum drug levels, and neurological status.

Diagnoses:

  • Risk for hepatotoxicity
  • Impaired skin integrity (due to rash)
  • Risk for bleeding (due to thrombocytopenia)

Implementation: Administer with food to decrease GI upset. Watch for signs of toxicity.

Evaluation: Assess seizure control, monitor for adverse effects, and ensure therapeutic serum levels.

Patient/Family Teaching

  • Take medication exactly as prescribed.
  • Report signs of liver problems (jaundice, abdominal pain), rash, bleeding, or mental status changes.
  • Avoid alcohol and CNS depressants.
  • Use contraception; do not use during pregnancy unless clearly indicated.

Special Considerations

Black Box Warnings:

  • Hepatotoxicity, fatal liver failure
  • Teratogenicity, including neural tube defects

Genetic Factors: Patients with mitochondrial disorders may have increased risk.

Lab Test Interference: May interfere with certain lab tests, including ammonia levels.

Overdose Management

Signs/Symptoms: Nausea, vomiting, blurred vision, ataxia, coma, hypotension, respiratory depression.

Treatment: Supportive care, activated charcoal if ingestion is recent, hemodialysis in severe cases, monitor vital signs and organ functions.

Storage and Handling

Storage: Store at room temperature, away from moisture and light.

Stability: Stable under recommended conditions for shelf life specified by manufacturer.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.