Valproic acid VPA is an organic weak acid, while its conjugate base is called valproate. The sodium salt of the acid is called sodium valproate and a coordination complex of the two is known as divalproex sodium DVP. Evidence has shown that both have similar efficacy in treatment of psychiatric disorders. Introduction to Mood Stabilizers and Anticonvulsants.
Carbamazepine Tegretol. Gabapentin Neurontin. Lamotrigine Lamictal. Levetiracetam Keppra. Phenytoin Dilantin. Pregabalin Lyrica. Oxcarbazepine Trileptal. See also article: Introduction to Pharmacology. Absorption Valproate ions are absorbed in the GI tract. The rate of absorption depends on the compound preparation gel, liquid, capsule and GI tract e. Side effects and metabolism also vary as a result of this. However, the free VPA plasma level doubles in renal impairment, so the total valproate level may be misleading.
Elimination Urine Half-life 10 to 16 hours. Substrate of Metabolized by None significant Induces - Inhibits -. This is thought to have direct neuronal effects on sodium influx and potassium efflux, and numerous other effects e. Bipolar disorder in adults. Not approved for any psychiatric indication in children or adolescents in Canada or USA, though it is used:.
Valproic acid Tradename: Depakene. Plasma valproic acid levels should be taken 10—14 hours ideally 12 hours after the last dose. Therefore, your patients should not be taking it the morning of the bloodwork! There were no differences in the discontinuation of either medicine because of side effects, or in the use of medications to treat gastrointestinal side effects.
Efficacy was similar for valproic acid and divalproex sodium. In addition, the hour formulation is the only one approved for smoking cessation and is available under the brand names Zyban and Buproban. Be sure if the patient is taking it for this indication that the prescription is written for the hour formulation.
Divalproex sodium Depakote , sodium valproate, and valproic acid are often confused. Sodium valproate, on the other hand, is the sodium salt of valproic acid. Divalproex is a compound containing sodium valproate and valproic acid that are bonded together with the sodium atom and is formed by partially neutralizing valproic acid with sodium hydroxide.
The different formulations, however, are not AB-rated and thus not interchangeable. Depakote is available in both a delayed release and extended release formulation among others and, just as with bupropion, it is best not to assume that all patients follow the typical dosing ie once daily for extended release and twice daily for delayed release. Macrobid [package insert]. Procter and Gamble Pharmaceuticals Inc.
Macrodantin [package insert]. American Geriatrics Society. Piepho R. Epilepsy Behav ; Reed RC, Dutta S. Predicted serum valproic acid concentrations in patients missing and replacing a dose of extended-release divalproex sodium.
Am J Health Syst Pharm ; Despland PA. A retrospective study of epileptic patients treated with sustained-release valproate. Epilepsia ;S Does it really matter when a blood sample for valproaic acid concentration is taken following once-daily administration of divalproex-ER? Ther Drug Monit ; Pharmacokinetics and safety of extended-release divalproex sodium tablets: Morning versus evening administration.
Panda S, Radhakrishnan K. Two cases of valproate-induced hyperammonemic encephalopathy without hepatic failure. J Assoc Physicians India ; Divalproex extended-release versus the original divalproex tablet: Results of a randomized, crossover study of well-controlled epileptic patients with primary generalized seizures.
Comparative absorption profiles of divalproex sodium delayed-release vesus extended-release tablets - clinical implications. Ann Pharmacother ; Everyhour administration of extended-release divalproex in patients with epilepsy: Impact on plasma valproic acid concentrations.
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