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Name: Valproic acid
Pregnancy Category D
Mechanism of action not understood: antiepileptic activity may be
to the metabolism of the inhibitory neurotransmitter, gamma-aminobutyric
acid (GABA); divalproex sodium is a compound containing equal
of valproic acid and sodium valproate.
Sole and adjunctive therapy in simple (petit mal) and complex absence
Adjunctive therapy in patients with multiple seizure types, including
Unlabeled uses: sole and adjunctive therapy in atypical absence,
myoclonic and grand mal seizures; possibly effective therapy in atonic,
complex partial, elementary partial, and infantile spasm seizures; prophylaxis for recurrent febrile seizures in children
Contraindicated in the presence of hypersensitivity to valproic acid,
hepatic disease or significant hepatic dysfunction.
Use caution in the presence of children younger than 18 mo; children
younger than 2 y, especially those receiving multiple antiepileptic
drugs, those with congenital metabolic disorders, those with severe
seizures accompanied by severe mental retardation, those with organic
brain disorders (higher risk of developing fatal hepatotoxicity);
pregnancy (incidence of neural tube defects in the fetus may be
in mothers receiving valproic acid during the first trimester of
pregnancy; do not discontinue antiepileptic therapy in pregnant women
are receiving such therapy to prevent major seizures; discontinuing
medication is likely to precipitate status epilepticus, with attendant
hypoxia and risk to both mother and unborn child); lactation.
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- CNS: Sedation, tremor (may be dose-related), emotional upset,
depression, psychosis, aggression, hyperactivity, behavioral
- GI: Nausea, vomiting, indigestion, diarrhea, abdominal cramps,
constipation, anorexia with weight loss, increased appetite with
- Hematologic: Slight elevations in SGOT, SGPT, LDH; increases in serum
bilirubin, abnormal changes in other liver function tests, hepatic
failure, altered bleeding time; thrombocytopenia; bruising; hematoma
formation; frank hemorrhage; relative lymphocytosis;
leukopenia, eosinophilia, anemia, bone marrow suppression
- GU: Irregular menses, secondary amenorrhea
- Dermatologic: Transient increases in hair loss, skin rash, petechiae