Details About Generic Salt ::  Valproic acid 

Main Medicine Class:: #N/A   Sub Medicine Class ::  #N/A

also comes under 1C. Anti-Epileptics in 1. Nervous System,  ,   1E. Anti-Psychotics in 1. Nervous System
PK: A: Rapid D: Total valproate 11L/1.73 m2, free valproate 92 L/1.73 m2 M: Hepatic E: Urine

Indications & Dose: COMPLEX PARTIAL SEIZURES IV/PO Adult Initially 10-15mg/kg/day, increase by 5-10mg/kg/day at wk intervals until therapeutic levels are achieved, max 60mg/kg/day Child >10 yr: Same as adult doseWhen using IV method, drug is infused over 60min at a rate of =< 20mg/min with the same frequency as oral products | MANIA Acute PO Adult Initially 750mg/day in divided doses, max 60mg/kg/day | MIGRAINE Prophylactic therapy PO Child >12 yr: 250mg BID, adjust dose according to response up to 1g/day | SIMPLE & COMPLEX ABSENCE SEIZURES Chronic PO Adult Initially 15mg/kg/day, increase by 5-10mg/kg/day at wk intervals until therapeutic levels are achieved, max 60mg/kg/day Child Same as adult dose

Contra: Hypersensitivity, active liver disease, family history of severe hepatic dysfunction, pancreatitis, porphyria

Precautions: Avoid abrupt withdrawal, hepatic/renal impairment, systemic lupus erythematous, before major surgery, anticoagulant therapy

ADR: Serious: SJS, TEN, thrombocytopenia, pancreatitis, hepatic dysfunction, extrapyramidal symptoms, dementia, encephalopathy, hyponatremia, coma, hepatitis, hyperammonemia, Others: edema, nausea, dizziness, diarrhea, gastric irritation, irritability, confusion, hallucinations, headache, hirsutism, weight gain, lethargy, pancytopenia, tremor, myalgia

DDI: Serious Nevirapine and ritonavir-boosted saquinavir causes hepatotoxicity, Zidovudine bioavailability is increased that may lead to severe anemia, Chlorpromazine causes severe hepatotoxicity, Isoniazid/Erythromycin causes valproate toxicity, Felbamate clearance decreases and it raises the drug levels leads to toxicity, Aspirin develops valproate toxicity, Dexamphetamine effects like mood changes and blood pressure are reduced by drug, Clobazam increases drug level, Cisplatin increases hematological toxicity, Lopinavir level is increased, Quetiapine level is modestly increased, Nifedipine/Amitriptyline/Nimodipine/Nortriptyline levels are increased, Olanzapine levels are reduced and the risk of hepatic injury is increased in children, Ethosuximide levels increases, Phenobarbital levels may be increased that may lead to excessive sedation and lethargy, Bupropion major active metabolites level increases by drug, Risperidone may cause edema, Zolpidem may cause sleepwalking, Topiramate may increase the risk of encephalopathy in individuals with pre-existing encephalopathy, Ritonavir may reduce drug level, Lorazepam/Diazepam/Midazolam plasma levels are increased, Colestyramine reduces drug absorption, Carbapenems reduces drug serum level Others Carbamazepine decreases serum drug level

Diet: With food

Monitor: LFTs, CBC with platelet, PT/PTT, drug levels, suicidality

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