THERAPEUTICS

Brands

• Depakote, Depakote ER, Depakene, Depacon, Episenta, Epilim, Epival, Dicorate, Disorate, Divaa, Divalpro, Soval DX, Trend XR, Valna, Stavzor

Generic?

• Yes

Class

• Antiepileptic drug (AED)

Commonly Prescribed for

(FDA approved in bold)

• Complex partial seizures (monotherapy and adjunctive)

• Simple and complex absence seizures (monotherapy and adjunctive)

• Adjunctive therapy for multiple seizure types, including absence seizures

• Migraine prophylaxis (delayed-release capsule only)

• Acute mania in bipolar disorder (delayed-release capsule only)

• Cluster headache

• Generalized tonic-clonic seizures, including juvenile myoclonic epilepsy

• Lennox-Gastaut syndrome

• Status epilepticus

• Post-hypoxic myoclonus

• Landau-Kleffner syndrome (acquired epileptic aphasia)

• Spinal muscular atrophy

• Acute migraine or status migrainosus

• Schizophrenia/psychosis

• Cyclothymia

How the Drug Works

The mechanisms of action of valproic acid and derivatives (DPX) are probably multiple

• Activates glutamic acid decarboxylase to increase GABA production

• Inhibits GABA transaminase and the catabolism of GABA

• Sodium channel antagonist

• Blocks T-type calcium currents in thalamus

• Suppresses NMDA excitatory neurotransmission

How Long Until It Works

• Seizures: 2 weeks

• Migraines: effective within a few weeks but can take up to 3 months to see full effect

• Mania: usually effective in days

If It Works

• Seizures: goal is the remission of seizures. Continue as long as effective and well tolerated. Consider slowly tapering and stopping after 2 years seizure-free, depending on the type of epilepsy

• Migraine: goal is a 50% or greater reduction in migraine frequency or severity. Consider tapering or stopping if headaches remit for more than 6 months or if patient considering pregnancy

If It Doesn't Work

• Increase to highest tolerated dose. Check a drug level if compliance an issue

• Epilepsy: consider changing to another agent, adding a second agent, using a medical device, or a referral for epilepsy surgery evaluation. When adding a second agent, keep drug interactions in mind

• Migraine: address other issues, such as medication overuse, other coexisting medical disorders, such as anxiety, and consider changing to or adding a second agent