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Valproate semisodium (INN, BAN) or divalproex sodium (USAN) consists of a compound of sodium valproate and valproic acid in a 1:1 molar relationship in an enteric coated form. Its chief use in medicine is as a treatment for bipolar disorder, epilepsy and in the prevention of migraines.
Valproic acid (VPA, valproate), an acidic chemical compound, has found clinical use as an anticonvulsant and mood-stabilizing drug, primarily in the treatment of epilepsy, bipolar disorder and prevention of migraine headaches. VPA is a liquid at room temperature, but it can be reacted with a base such as sodium hydroxide to form the salt sodium valproate, which is a solid.
The acid, salt, or a mixture of the two (valproate semisodium) are marketed under a number of different brand names, including: Depakote, Epilim, Valparin, Valpro, Vilapro and Stavzor. It is on the World Health Organization's List of Essential Medicines, a list of the most important medication needed in a basic health system.
Adverse effects
The most common adverse effects of valproic acid are digestive complaints like diarrhoea, nausea, vomiting and indigestion; vision problems like seeing double or lazy eye; hormonal disturbances (increased testosterone production in females and menstrual irregularities), hair loss, memory problems, weight gain, infections, low platelet count (which can make one bleed more easily), infection, dizziness, drowsiness, tremor and headache.Less common, yet serious side effects include liver damage, brittle bones (becomes far more common with long-term use), polycystic ovaries, movement disorders (which may be irreversible like tardive dyskinesia), psychiatric/neurologic disturbances like hallucinations, anxiety and confusion; swollen pancreas, low body temperature and potentially life-threatening blood abnormalities
Mechanism of action
Although the mechanism of action of valproate is not fully understood,it has recently been shown to protect against a seizure-induced reduction in phosphatidylinositol (3,4,5)-trisphosphate (PIP3) as a potential therapeutic mechanism.In addition, its anticonvulsant effect has been attributed to the blockade of voltage-dependent sodium channels and increased brain levels of gamma-aminobutyric acid (GABA). The GABAergic effect is also believed to contribute towards the anti-manic properties of valproate. In animals, sodium valproate raises cerebral and cerebellar levels of the inhibitory synaptic transmitter, GABA, possibly by inhibiting GABA degradative enzymes, such as GABA transaminase, succinate-semialdehyde dehydrogenase and by inhibiting the re-uptake of GABA by neuronal cells.It also possesses histone deacetylase-inhibiting effects. The inhibition of histone deacetylase, by promoting more transcriptionally active chromatin structures, likely presents the epigenetic mechanism for regulation of many of the neuroprotective effects attributed to valproic acid. Intermediate molecules mediating these effects include VEGF, BDNF, and GDNF.
History
Valproic acid was first synthesized in 1882 by B.S. Burton as an analogue of valeric acid, found naturally in valerian.Valproic acid is a carboxylic acid, a clear liquid at room temperature. For many decades, its only use was in laboratories as a "metabolically inert" solvent for organic compounds. In 1962, the French researcher Pierre Eymard serendipitously discovered the anticonvulsant properties of valproic acid while using it as a vehicle for a number of other compounds that were being screened for antiseizure activity. He found it prevented pentylenetetrazol-induced convulsions in laboratory rats. It was approved as an antiepileptic drug in 1967 in France and has become the most widely prescribed antiepileptic drug worldwide.Valproic acid has also been used for migraine prophylaxis and bipolar disorder.
Mechanism
The precise mechanism of action of lithium is still unknown, and it is suspected that it acts at various points of the neuron between the nucleus and the synapse. Lithium is known to inhibit the enzyme GSK-3B. This has the effect relieving pressure on the circadian clock - which is thought to be often malfunctioning in people with bipolar disorder - and positively modulates gene transcription of brain-derived neurotrophic factor (BDNF). The resulting increase in neural plasticity may be central to lithium's therapeutic effects. Lithium may also increase the synthesis of serotonin
If you are allergic to tartrazine, talk with healthcare provider. Some products contain tartrazine.
If you have an allergy to any type of nuts or seeds, talk with healthcare provider. Some products contain nuts.
Check medicines with healthcare provider. This medicine may not mix well with other medicines.
Tell healthcare provider if you are pregnant or plan on getting pregnant.
Tell healthcare provider if you are breast-feeding.
What are some possible side effects of this medicine?
Skin irritation.
Reasons to call healthcare provider immediately
If you suspect an overdose, call your local poison control center or emergency department immediately.
Signs of a life-threatening reaction. These include wheezing; chest tightness; fever; itching; bad cough; blue skin color; fits; or swelling of face, lips, tongue, or throat.
Severe skin irritation.
Any rash.
No improvement in condition or feeling worse.
Trolamine salicylate is used to treat minor aches and pains of the muscles/joints (such as arthritis, backache, sprains). It belongs to a class of drugs known as salicylates.
How to use divalproex oral
Follow all directions on the product package. If you are uncertain about any of the information, consult your doctor or pharmacist.
This medication is for use on the skin only. Do not get this medication in your eyes, inside your nose or mouth, or inside the vagina. If you do get the medication in those areas, flush with plenty of water.
Apply the medication to the affected area no more than 3 to 4 times a day. Rub in gently and thoroughly. After applying the medication, wash your hands unless you are using this medication to treat the hands.
Do not apply this medication on broken or irritated skin. Do not bandage or tightly wrap the affected area or apply heat to the area (such as using a heating pad). Doing so may increase the risk of side effects. Ask your pharmacist for more details.
Tell your doctor if your condition persists for more than 7 days, if it worsens, or if it keeps returning. If you think you may have a serious medical problem, get medical help right away.
If your doctor has directed you to use this medication, remember that he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.
Stop using this medication and tell your doctor right away if any serious side effects occur, including: blistering/peeling/redness/irritation at the application site, nausea/vomiting, ringing in the ears.
A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.
This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.
Before using trolamine salicylate, tell your doctor or pharmacist if you are allergic to it; or to aspirin or other salicylates (such as salsalate); or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.
Before using this medication, tell your doctor or pharmacist your medical history, especially of: asthma, growths in the nose (nasal polyps).
Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).
This drug is similar to aspirin. Children and teenagers should not use this drug if they have chickenpox, flu, or any undiagnosed illness or if they have recently received a vaccine. In these cases, this drug may increase the risk of Reye's syndrome, a rare but serious illness.
During the first 6 months of pregnancy, this medication should be used only when clearly needed. It is not recommended for use during the last 3 months of pregnancy due to possible harm to the unborn baby and problems with normal labor/delivery. Discuss the risks and benefits with your doctor.
It is unknown if this product passes into breast milk. Consult your doctor before breast-feeding.
Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.
This medicine may be harmful if swallowed. If swallowing or overdose is suspected, contact a poison control center or emergency room immediately.
Notes
Keep all regular medical and laboratory appointments.
Missed Dose
If you miss a dose, use it as soon as you remember. If it is near the time of the next dose, skip the missed dose and resume your usual dosing schedule. Do not double the dose to catch up.
Storage
Store at room temperature away from heat, light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.
Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.
Information last revised September 2013. Copyright(c) 2013 First Databank, Inc.
