Diferencia entre revisiones de «Valproic acid»

(Valproic Acid page)
 
 
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==Administration==
==Administration==
*Type: Anticonvulsant
*Type: [[Anticonvulsant]]
*Dosage Forms: 250mg, 250/5 mL
*Dosage Forms: 250mg, 250/5 mL
*Routes of Administration: Oral, IV
*Routes of Administration: Oral, IV
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==Adult Dosing==
==Adult Dosing==
*Complex partial seizures: 30-60 mg/kg/day PO (divided bid-tid)
*Complex partial seizures: 30-60mg/kg/day PO (divided bid-tid)
**Start: 10-15 mg/kg/day PO divided qd-tid
**Start: 10-15mg/kg/day PO divided QD-tid
**Increase by 5-10 mg/kg/day q7 days
**Increase by 5-10mg/kg/day q7 days
**Max: 60 mg/kg/day
**Max: 60mg/kg/day
**Decrease start dose and titrate slowly in elderly pts
**Decrease start dose and titrate slowly in elderly patients
**Adjust dose based on tx response and serum levels
**Adjust dose based on treatment response and serum levels
**Divide doses >250 mg/day
**Divide doses >250mg/day
**Do not cut/crush/chew/open caps
**Do not cut/crush/chew with outpen caps
**Taper dose gradually to D/C
**Taper dose gradually to discontinue
**Total daily IV dose should equal total oral daily dose
**Total daily IV dose should equal total oral daily dose
**Administer IV dose as a 60-minute infusion (≤20 mg/minute)
**Administer IV dose as a 60-minute infusion (≤20mg/minute)


*Absence seizures, simple and complex:  30-60 mg/kg/day PO (divided bid-tid)
*Absence seizures, simple and complex:  30-60mg/kg/day PO (divided bid-tid)
**Start: 15 mg/kg/day PO divided qd-tid, increase by 5-10 mg/kg/day every 7 days
**Start: 15mg/kg/day PO divided QD-tid, increase by 5-10mg/kg/day every 7 days
**Max: 60 mg/kg/day
**Max: 60mg/kg/day


*Bipolar disorder, acute mania: 250-500 mg PO tid
*Bipolar disorder, acute mania: 250-500mg PO tid
**Start: 250 mg PO tid, may increase dose rapidly to lowest effective dose
**Start: 250mg PO tid, may increase dose rapidly to lowest effective dose
**Max: 60 mg/kg/day
**Max: 60mg/kg/day
**Decrease start dose and titrate slowly in elderly pts
**Decrease start dose and titrate slowly in elderly patients


*Migraine headache prophylaxis: 250-500 mg PO bid
*Migraine headache prophylaxis: 250-500mg PO bid
**Start: 250 mg PO bid
**Start: 250mg PO bid


*Status epilepticus (off-label use): IV loading dose: 20 to 40 mg/kg  
*Status epilepticus (off-label use): IV loading dose: 20 to 40mg/kg  
**Administer at rate of 3 to 6 mg/kg/min
**Administer at rate of 3 to 6mg/kg/min
**May give an additional dose of 20 mg/kg 10 minutes after the loading infusion
**May give an additional dose of 20mg/kg 10 minutes after the loading infusion


==Pediatric Dosing==
==Pediatric Dosing==
*Partial seizures, complex: 30-60 mg/kg/day PO divided bid-tid
*Partial seizures, complex: 30-60mg/kg/day PO divided bid-tid
**Start: 10-15 mg/kg/day PO divided qd-tid,  
**Start: 10-15mg/kg/day PO divided QD-tid,  
**Increase by 5-10 mg/kg/day q7 days; Max: 60 mg/kg/day;  
**Increase by 5-10mg/kg/day q7 days; Max: 60mg/kg/day;  
**Adjust dose based on tx response and serum levels
**Adjust dose based on treatment response and serum levels
**Not recommended under age 10
**Not recommended under age 10


*Absence seizures, simple and complex: 30-60 mg/kg/day PO divided bid-tid
*Absence seizures, simple and complex: 30-60mg/kg/day PO divided bid-tid
**Start: 15 mg/kg/day PO divided qd-tid  
**Start: 15mg/kg/day PO divided QD-tid  
**Increase by 5-10 mg/kg/day q7 days
**Increase by 5-10mg/kg/day q7 days
**Max: 60 mg/kg/day
**Max: 60mg/kg/day
**Not recommended under age 10
**Not recommended under age 10


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==Contraindications==
==Contraindications==
*Hypersensitivity to valproic acid
*Hypersensitivity to valproic acid
*Hepatic dz
*Hepatic disease
*Hepatic impairment, significant
*Hepatic impairment, significant
*Urea cycle disorders
*Urea cycle disorders
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===Serious===
===Serious===
*Hepatotoxicity
*Hepatotoxicity
*Pancreatitis
*[[Pancreatitis]]
*SIADH
*SIADH
*Hyponatremia
*[[Hyponatremia]]
*Pancytopenia
*Pancytopenia
*Thrombocytopenia
*[[Thrombocytopenia]]
*Drug rxn w/ eosinophilia and systemic sx
*[[Drug reaction with eosinophilia and systemic symptoms]]
*Hyperammonemia
*Hyperammonemia
*Hypothermia
*Hypothermia
*Myelosuppression
*Myelosuppression
*Aplastic anemia
*[[Aplastic anemia]]
*Bleeding
*Bleeding
*Erythema multiforme/SJS/TEN
*[[Erythema multiforme]]/SJS/TEN
 
===Common===
===Common===
*Headache
*Headache
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==Mechanism of Action==
==Mechanism of Action==
*Increases GABA effects, may inhibit glutamate/NMDA receptor-mediated neuronal excitation
*Increases GABA effects, may inhibit glutamate/NMDA receptor-mediated neuronal excitation
==See also==
*[[Valproate]]
*[[Valproic acid toxicity]]


==References==
==References==
<UptoDate, epocrates>
<UptoDate, epocrates>
[[Category:Drugs]]
[[Category:Pharmacology]]
[[Category:Neurology]]

Revisión actual - 19:19 20 feb 2021

Administration

  • Type: Anticonvulsant
  • Dosage Forms: 250mg, 250/5 mL
  • Routes of Administration: Oral, IV
  • Common Trade Names: Depacon; Depakene; Depakote; Depakote ER; Depakote Sprinkles; Stavzor

Adult Dosing

  • Complex partial seizures: 30-60mg/kg/day PO (divided bid-tid)
    • Start: 10-15mg/kg/day PO divided QD-tid
    • Increase by 5-10mg/kg/day q7 days
    • Max: 60mg/kg/day
    • Decrease start dose and titrate slowly in elderly patients
    • Adjust dose based on treatment response and serum levels
    • Divide doses >250mg/day
    • Do not cut/crush/chew with outpen caps
    • Taper dose gradually to discontinue
    • Total daily IV dose should equal total oral daily dose
    • Administer IV dose as a 60-minute infusion (≤20mg/minute)
  • Absence seizures, simple and complex: 30-60mg/kg/day PO (divided bid-tid)
    • Start: 15mg/kg/day PO divided QD-tid, increase by 5-10mg/kg/day every 7 days
    • Max: 60mg/kg/day
  • Bipolar disorder, acute mania: 250-500mg PO tid
    • Start: 250mg PO tid, may increase dose rapidly to lowest effective dose
    • Max: 60mg/kg/day
    • Decrease start dose and titrate slowly in elderly patients
  • Migraine headache prophylaxis: 250-500mg PO bid
    • Start: 250mg PO bid
  • Status epilepticus (off-label use): IV loading dose: 20 to 40mg/kg
    • Administer at rate of 3 to 6mg/kg/min
    • May give an additional dose of 20mg/kg 10 minutes after the loading infusion

Pediatric Dosing

  • Partial seizures, complex: 30-60mg/kg/day PO divided bid-tid
    • Start: 10-15mg/kg/day PO divided QD-tid,
    • Increase by 5-10mg/kg/day q7 days; Max: 60mg/kg/day;
    • Adjust dose based on treatment response and serum levels
    • Not recommended under age 10
  • Absence seizures, simple and complex: 30-60mg/kg/day PO divided bid-tid
    • Start: 15mg/kg/day PO divided QD-tid
    • Increase by 5-10mg/kg/day q7 days
    • Max: 60mg/kg/day
    • Not recommended under age 10

Special Populations

  • Pregnancy Risk Factor: X (migraine prophylaxis)/D (all other indications)

Renal Dosing

  • No adjustment necessary though may cause levels to be misleading

Hepatic Dosing

  • Mild to moderate impairment: Not recommended for use in hepatic disease; clearance is decreased with liver impairment
  • Severe impairment: Use is contraindicated.

Contraindications

  • Hypersensitivity to valproic acid
  • Hepatic disease
  • Hepatic impairment, significant
  • Urea cycle disorders
  • Mitochondrial disorder, POLG-related
  • Pregnancy (migraine headache prophylaxis use)

Adverse Reactions

Serious

Common

  • Headache
  • Nausea/vomiting
  • Asthenia
  • Somnolence
  • Thrombocytopenia
  • Dyspepsia
  • Dizziness

Pharmacology

  • Half-life: 16 hrs
  • Metabolism: CYP450
  • Excretion: Urine

Mechanism of Action

  • Increases GABA effects, may inhibit glutamate/NMDA receptor-mediated neuronal excitation

See also

References

<UptoDate, epocrates>

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