Valporic Acid

Indications

• Manic – 56% response rate (near Lithium effectiveness)
  • Level I evidence (A for mania and mixed states)
• Bipolar Depression – Few studies for bipolar depression
  • Level III evidence (B)
• Prophylaxis
  • Level II evidence (A)

Pharmacology

• 2 forms
  • Valproate and Divalproex sodium
  • Divalproex sodium (Epival) has less GI side effects, and is therefore preferred
• Half-life = 6-16 hours
• Metabolized by liver
• Protein bound

Side Effects

• GI distress (use divalproex sodium)
• Sedation
• Benign increased ALT, increased AST
• Tremor
• Hepatotoxicity
• Decreased platelets, WBC
• Increased appetite, weight
• Agranulocytosis
• Polycystic ovarian disease – contraindicated

When you start:

• Workup before starting
  • History And Physical
  • LFT’S
  • CBC with platelets
  • Do initially, then at 4 weeks, repeat q 3-6 months
• Starting Dose 250 mg BID
  • Increase by 250 mg Increments weekly
  • • teratogenic
• Levels
  • 350-700 μmol/L3