Generic Name and Formulations:
Valproic acid (as sodium) 100 mg/mL; soln for IV infusion after dilution; preservative-free.
Company:
AbbVie
Temporary alternative to oral valproate in patients with complex partial seizures, simple and complex absence seizures, and multiple seizure types that include absence seizures.
Give by IV infusion over 60 minutes (max 20 mg/minute) preferably at 6-hour intervals (doses up to 15 mg/kg over 5–10 minutes have been used: see literature). Absence seizures: initially 15 mg/kg per day, other uses initially 10–15 mg/kg per day; usual max 60 mg/kg daily. Switch to oral valproate as soon as possible. Give total daily doses >250 mg in divided doses. <2 years of age: not recommended. ≥2 years: Replacement therapy: switch on a mg/mg basis and give at the same dosing interval; titrate according to plasma valproate levels.
Valproic acid.
Hepatic disease or significant hepatic dysfunction. Urea cycle disorders.
Discontinue if hepatic dysfunction, pancreatitis, thrombocytopenia, or hyperammonemia occurs. History of liver disease; monitor liver function and clinical symptoms (esp. for 1st 6 months). Avoid abrupt cessation. Evaluate for urea cycle disorders. Increased risk of hepatotoxicity in patients with congenital metabolic disorders, multiple AEDs, severe seizure disorders with mental retardation, organic brain disorders, in children <2 years of age. May affect viral load in HIV or CMV infection. Monitor platelet counts, bleeding time (esp. if used in pregnancy). Suicidal tendencies (monitor). Elderly (monitor fluid and nutritional intake, and for dehydration, somnolence, tremor, other adverse reactions). Pregnancy (Cat.D): apprise female patients of childbearing potential of risks to fetus (eg, neural tube defects). Nursing mothers.
Monitor levels of valproate, ethosuximide, other anticonvulsants, and when an enzyme inducer is added or withdrawn. Potentiates carbamazepine, diazepam, lamotrigine, phenobarbital, phenytoin, tolbutamide, warfarin, zidovudine, amitriptyline, nortriptyline. Potentiated by aspirin, felbamate. Efficacy reduced by rifampin, phenytoin, carbamazepine, phenobarbital. CNS depression with alcohol, other CNS depressants. Clonazepam may induce absence status in patients with absence seizures. May interfere with urine ketone and thyroid tests. Others: see literature.
Dizziness, headache, local reactions, GI, dermatologic, psychiatric, endocrine, and CNS effects, weakness, thrombocytopenia, bone marrow suppression, hepatotoxicity, acute pancreatitis, hyperammonemia, metabolic abnormalities; rare: Fanconi's syndrome in children, Stevens-Johnson syndrome.
Single-dose vials (5 mL)—10