Valproic Acid Drug Study

In making a Drug Study, the following elements must be present: Generic Name and the Brand name (not all brands, just the brand used by the patient), Action, Indication, Pregnancy Category, Drug Classification, and Contraindication, Adverse Effect, Drug interaction and Nursing Consideration/Intervention…. Most clinical instructors preferred this to be in a long bond paper in printed or handwritten with paper in landscape.

Valproic acid

Pregnancy Category D

Drug class: Antiepileptic agent

Therapeutic actions

Mechanism of action not understood: antiepileptic activity may be related to the metabolism of the inhibitory neurotransmitter, gamma-aminobutyric acid (GABA); divalproex sodium is a compound containing equal proportions of valproic acid and sodium valproate.

Indications

· Sole and adjunctive therapy in simple (petit mal) and complex absence seizures

· Adjunctive therapy with multiple seizure types, including absence seizures

· Treatment of mania (divalproex)

· Prophylaxis of migraine headaches (divalproex-DR tablets)

· Treatment of complex partial seizures as monotherapy or with other antiepilepsy drugs (divalproex, sodium valproate injection)

· Unlabeled uses: sole and adjunctive therapy in atypical absence, myoclonic and grand mal seizures; possibly effective therapy in atonic, elementary partial, and infantile spasm seizures; prophylaxis for recurrent febrile seizures in children

Contraindications

· Contraindicated with hypersensitivity to valproic acid, hepatic disease or significant hepatic dysfunction.

· Use cautiously with children <>

Adverse effects

Sedation, tremor (may be dose-related), emotional upset, depression, psychosis, aggression, hyperactivity, behavioral deterioration, weakness

Transient increases in hair loss, rash, petechiae

Nausea, vomiting, indigestion, diarrhea, abdominal cramps, constipation, anorexia with weight loss, increased appetite with weight gain, life-threatening pancreatitis, hepatic failure

Irregular menses, secondary amenorrhea

Slight elevations in AST, ALT, LDH; increases in serum bilirubin, abnormal changes in other liver function tests, altered bleeding time; thrombocytopenia; bruising; hematoma formation; frank hemorrhage; relative lymphocytosis; hypofibrinogenemia; leukopenia, eosinophilia, anemia, bone marrow suppression

Drug Interactions:

· Increased serum phenobarbital, primidone, ethosuximide, diazepam, zidovudine levels

· Complex interactions with phenytoin; breakthrough seizures have occurred with the combination of valproic acid and phenytoin

· Increased serum levels and toxicity with salicylates, cimetidine, chlorpromazine, erythromycin, felbamate

· Decreased effects with carbamazepine, rifampin, lamotrigine

· Decreased serum levels with charcoal

· Increased sedation with alcohol, other CNS depressants

Nursing considerations

CLINICAL ALERT!

Confusion has occurred between delayed release Depakote and Depakote ER. Dosage is very different and serious adverse effects can occur; use extreme caution.

· Give drug with food if GI upset occurs; substitution of the enteric-coated formulation also may be of benefit; have patient swallow SR tablet whole; do not cut, crush, or chew.

· Reduce dosage, discontinue, or substitute other antiepileptic medication gradually; abrupt discontinuation of all antiepileptic medication may precipitate absence status.

· Arrange for frequent liver function tests; discontinue drug immediately with significant hepatic dysfunction, suspected or apparent; hepatic dysfunction has progressed in spite of drug discontinuation.

· Arrange for patient to have platelet counts, bleeding time determination before therapy, periodically during therapy, and prior to surgery. Monitor patient carefully for clotting defects (bruising, blood tinged toothbrush). Discontinue if there is evidence of hemorrhage, bruising, or disorder of hemostasis.

· Monitor ammonia levels, and discontinue if there is clinically significant elevation in level.

· Monitor serum levels of valproic acid and other antiepileptic drugs given concomitantly, especially during the first few weeks of therapy. Adjust dosage on the basis of these data and clinical response.

· Arrange for counseling for women of childbearing age who wish to become pregnant.

· Discontinue drug at any sign of pancreatitis.

· Evaluate for therapeutic serum levels--usually 50–100 mcg/mL.