Valproic acid is listed as an Essential Medicine on the World Health Organisation's list of Essential Medicines. The medication's effectiveness comes with important considerations. The US Food and Drug Administration gave its first approval in 1978 for treating absence seizures. New applications emerged over the last several years. These included complex partial seizures and migraine prevention. This article covers everything patients and caregivers should know about valproic acid. Readers will learn about its mechanisms, proper dosage guidelines, potential side effects, and safety precautions.

What is Valproic Acid?

Valproic acid belongs to the fatty acid derivative class. This antiepileptic medication helps control seizures by calming abnormal brain activity. Patients can take it in several forms such as capsules, tablets, sprinkles, and syrup. The drug is well absorbed and extensively metabolised in the liver. Valproic acid has a broad spectrum of action and is an important agent in neurological & mood issues.

How Does Valproic Acid Work?

The medicine increases GABA (gamma aminobutyric acid) transmission in the brain that creates a calming effect. It blocks specific ion channels and stops histone deacetylase, which affects gene transcription.

Uses of Valproic Acid

Doctors use valproic acid to treat:

• Absence seizures

• Complex partial seizures

• Multiple seizure disorders

• Manage bipolar disorder 

• Prevent migraines.

How & When to Take Valproic Acid?

• Your doctor's prescription should guide your intake, which usually means taking it 2-3 times daily.

• You can take the medicine with food to avoid stomach upset. 

• Do not crush or chew extended-release tablets as they lose their effectiveness.

• Take the medicine at the same time every day to maintain its blood levels.

• Stopping the medication suddenly might trigger seizures, so always consult your doctor first.

Side Effects of Valproic Acid

Common side effects:

• Stomach pain

• Nausea or vomiting

• Drowsiness and dizziness

• Weight gain

• Hair thinning or loss

• Tremors.

Some patients notice their hair getting thinner or changing texture, but this usually gets better within six months.

Serious effects like liver problems, pancreatitis, unusual bruising, or suicidal thoughts need immediate medical attention.

Dosage for Valproic Acid

For epilepsy - Adults and children over 10 years are prescribed 10-15 mg/kg/day. Doctors gradually increase the dose by 5-10 mg/kg weekly as needed. 

Bipolar disorder - 750-2000 mg daily split into multiple doses

Migraine prevention - 500-1000 mg daily

Your doctor might adjust these amounts based on your specific situation.

Can I Take Valproic Acid Daily?

Valproic acid needs daily administration to maintain steady blood levels. Most patients take it 2-3 times daily with food, which helps prevent stomach upset. The ideal gap between doses should be 10-12 hours for twice-daily dosing usually morning and evening.

Precautions 

• The medication isn't safe for people with liver problems. Doctors monitor your liver functions regularly. 

• Women who are pregnant should tell their doctor as this medication can cause birth defects. 

• Tell your doctor if you have liver disease, pancreatitis, or metabolic disorders before starting this medicine.

• The medication isn't safe if you have urea cycle disorders or POLG gene mutations (like Alpers-Huttenlocher Syndrome). 

• Do not drink alcohol while taking this medicine as it increases the risk of liver toxicity.

What If You Missed a Dose?

You should take the missed dose when you remember it, unless your next dose is coming up soon. In that case, skip the missed dose entirely. Never take a double dose to catch up. Missed doses might trigger seizures, so setting alarms helps you stay on track.

What If You Overdose?

Drowsiness, irregular heartbeat, vomiting, confusion and possibly coma are common overdose symptoms. You should call emergency services immediately if you suspect an overdose. 

Caution With Other Drugs: Interactions

Valproic acid can interact with many drugs. Some of these are:

• Aspirin 

• Blood thinners like warfarin

• Cannabis

• Carbamazepine 

• Clarithromycin

• Estradiol

• Fosphenytoin

• Isoniazid

• Methadone

• Methotrexate

• Nifedipine

• Orlistat

• Phenobarbital

• Phenytoin

• Primidone

• Ritonavir

• Topiramate

• Zidovudine.

Valproic Acid vs Carbamazepine

Doctors must choose between valproic acid and carbamazepine to treat epilepsy. These medications excel in different scenarios.

Both medications work equally well to treat secondarily generalised tonic-clonic seizures. Carbamazepine shows better results in controlling complex partial seizures. A comprehensive study confirmed carbamazepine's superiority in managing partial seizures through various metrics like total seizure count and monthly seizure frequency.

These medications show distinct differences in their side effect profiles:

• Valproic acid more commonly causes weight gain, hair loss or texture changes, and tremors. 

• Carbamazepine more frequently causes rash.

Patient age plays a crucial role in medication effectiveness - younger patients respond better to valproic acid, while older patients show better results with carbamazepine. Women who take valproic acid face a higher risk of metabolic syndrome compared to men.

Drug interaction patterns differ significantly between these medications. Carbamazepine interacts with more drugs than valproic acid.

Doctors typically favours valproate for generalised epilepsies and carbamazepine for partial epilepsies. 

FAQs

1. What is Valproic Acid used for?

We used valproic acid to treat epilepsy in patients with different types of seizures. This medication also works as a mood stabiliser for bipolar disorder, especially when you have manic episodes. Patients get great results when using it to prevent migraine headaches. The medication's unique effect on brain chemicals makes it versatile.

2. Can Valproic Acid treat seizures or epilepsy?

Yes, it can. Valproic acid helps patients with several types of seizure disorders. The medication works best for:

• Absence seizures (brief episodes of altered consciousness)

• Complex partial seizures

• Tonic-clonic seizures

• Myoclonic seizures

Doctors give this medication through IV to treat status epilepticus (a dangerous condition where seizures don't stop).

3. How should I take Valproic Acid tablets or syrup?

Take valproic acid capsules whole with a full glass of water. Your mouth and throat might get irritated if you break or chew them. The syrup tastes better when mixed with other liquids or food. Taking doses with meals helps reduce stomach problems. 

4. What are the common side effects of Valproic Acid?

Common side effects:

• Stomach pain

• Nausea

• Diarrhoea 

• Drowsy

• Headaches

• Weight gain

• Tremors.

5. Can Valproic Acid affect the liver?

Valproic acid can damage your liver. Blood tests must check your liver function regularly, especially in the first six months. Watch out for yellow skin or eyes, dark urine, unusual tiredness, or pain in your upper stomach. 

6. Who should avoid taking Valproic Acid?

Patients with liver disease cannot take this medication. Women who are pregnant should stay away from valproic acid because it can harm the baby. Doctors need to be extra careful with children under two years due to increased liver toxicity risks.

7. Is Valproic Acid safe during pregnancy?

Absolutely not. Valproic acid causes serious birth defects and developmental problems in babies. Neural tube defects occur 10 times more frequently than in the normal population. Regulatory agencies strongly advise against using it during pregnancy, especially to prevent migraines. Women who are planning to have children must use effective contraception throughout treatment. 

8. Can I take Valproic Acid with other medicines?

Valproic acid interacts with many drugs. Common interacting medicines include:

• Aspirin 

• Blood thinners 

• Certain antibiotics like erythromycin

• Other epilepsy medications such as carbamazepine

• Mental health medicines like diazepam.

9. How long does Valproic Acid take to show effects?

Seizure control usually takes several days to weeks. The medicine needs a similar time to stabilise the mood.

10. What should I do if I miss a dose of Valproic Acid?

Take the medicine as soon as you remember, unless it's almost time for your next dose. Never take two doses together. Setting alarms helps you stay on track.