Valproate for Epilepsy
|Generic Name||Brand Name|
|valproate||Depakene, Divalproex, Epival|
Valproate is available in capsules, tablets, and syrups that you take by mouth. It can also be given as a shot.
How It Works
It is not clear how valproate prevents seizures . But it may prevent them by increasing levels of a certain chemical in the brain.
Why It Is Used
Valproate is a drug of choice for:
- Generalized epilepsy of unknown cause that produces more than one type of seizure.
- Absence seizures . If a person has absence seizures as well as other types of seizures, valproate usually works well because it can control several types of seizures.
- Myoclonic seizures, such as those caused by juvenile myoclonic epilepsy.
- Valproate is also considered a first-line drug for treating partial seizures .
How Well It Works
Valproate prevents seizures in most people who use it to control complex partial seizures and absence seizures. It is also effective against generalized tonic-clonic seizures, myoclonic seizures, and atonic seizures. 1
Common side effects of valproate include:
- Nausea, vomiting, and stomach cramps.
- Weight gain.
- Tremors and shaking.
- Temporary hair loss.
- Irregular menstrual cycle.
These side effects may increase as the dosage needed to control seizures increases. Because valproate levels in the body tend to go up and down, some side effects may vary from day to day or even within a single day. Nausea and stomach problems usually go away after the body adjusts to the drug. Hair loss, weight gain, and tremors often come with long-term use of the drug.
Skin rash, a very common side effect of antiepileptic drugs, is less common with valproate. Valproate tends to have less effect on your thinking, memory, or learning processes than other antiepileptic drugs (as long as the drug levels in your bloodstream do not become too high).
The U.S. Food and Drug Administration (FDA) has issued a warning on antiepileptic medicines and the risk of suicide and suicidal thoughts. The FDA does not recommend that people stop using these medicines. Instead, people who take antiepileptic medicine should be watched closely for warning signs of suicide. People who take antiepileptic medicine and who are worried about this side effect should talk to a doctor.
See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)
What To Think About
It may take time and careful, controlled adjustments by you and your doctor to find the combination, schedule, and dosing of medicine to best manage your epilepsy . The goal is to prevent seizures while causing as few side effects as possible. After you and your doctor figure out the program that works best for you, make sure to follow your program exactly as prescribed.
- Adverse effects. The weight gain that can result from use of valproate can be quite significant and is a major concern for some people. High levels of valproate may also cause severe tremors that make certain types of work and activities quite difficult.
- Serious health risks. Valproate may cause liver damage (called hepatotoxicity). This liver damage can be fatal, although only children younger than age 10 have died from it. Children ages 2 and younger who are taking more than one drug and have other brain and nervous system disorders are at highest risk. Routine blood tests and careful monitoring can lower the risk. The risk of liver disorders caused by valproate is extremely low in adults.
- Drug interactions. Many medicines for epilepsy can interact with other medicines you may be taking. This means that your epilepsy medicine may not work as well, or it may affect the way another medicine that you are taking works. Some of these interactions can be dangerous. Make sure to tell your doctor about all the medicines, herbal pills, and dietary supplements you are taking. Valproate is a good choice for women taking birth control pills, because it will not reduce the effectiveness of the pills.
- Risk of birth defects. All medicines for epilepsy have some risk of birth defects. But the risk of birth defects needs to be carefully compared to other risks to the baby if the mother stops taking her epilepsy medicine. If you are thinking about becoming pregnant, be sure to plan ahead and talk with your doctor about the benefits and risks of taking epilepsy medicine during your pregnancy. It you are already pregnant, it is not too late. The best thing to do is talk to your doctor about your pregnancy before you make any changes to the medicines you are taking. Your doctor may be especially concerned about valproate use. One study found a link between valproate use during the first trimester and a higher risk of having a baby with birth defects. Pregnant women who used valproate during the first trimester had a higher risk of having a baby with birth defects than pregnant women who took no medicine for their epilepsy or who took a different antiepileptic medicine during the first trimester. 2
- Other concerns. For some people, valproate may cause side effects or carry risks that are not yet fully known. Report any unexpected side effects or problems to your doctor.
- Drugs for epilepsy (2008). Treatment Guidelines From The Medical Letter, 6(70): 37–46.
- Jentink J, et al. (2010). Valproic acid monotherapy in pregnancy and major congenital malformations. New England Journal of Medicine, 362(23): 2185–2193.
Last Revised: April 10, 2012
Author: Healthwise Staff
Medical Review: Susan C. Kim, MD – Pediatrics & Brian D. O’Brien, MD – Internal Medicine &Steven C. Schachter, MD – Neurology