VALPROATE (‘Epilim’, ‘Depakote’, ‘Convulex’)
Val – pro – ate
Why have I been prescribed valproate?
Valproate is usually used to help treat mood swings, as happens in bipolar affective disorder or manic depression. People
with bipolar affective disorder have mood swings that are much more severe than the small changes in mood that
everybody experiences. With bipolar affective disorder, mood may be elevated or depressed (up or down).
When the mood is extremely elevated this is called hypomania or mania. People with hypomania feel very energetic and
elated but can be irritable and frustrated. They may talk very quickly, sleep very little and be full of ideas and plans. They
can be described as being “high”. Treatment is usually needed because when people are “high” they may make poor
judgements and can quickly become exhausted. Periods of depression will also occur in bipolar disorder. Symptoms
include feelings of sadness, tiredness and poor sleep. Antidepressants may be required to help lessen these obviously
unpleasant symptoms. Valproate helps stabilise the mood and helps reduce the highs.
Valproate is also an anticonvulsant, used to help manage epileptic fits or seizures.
What exactly is valproate?
Valproate can be described as an anticonvulsant, antimanic or mood stabiliser. It is unclear exactly how it works. Valproate
is available in a number of similar forms, either sodium valproate or valproic acid:
Depakote’ is a mixture of sodium valproate and valproic acid known as valproate semisodium (or divalproex in USA)
Epilim’ contains sodium valproate
Epilim Chrono’ is a mixture of sodium valproate and valproic acid
Convulex’ contains valproic acid.
These are very similar, but it is always best to make sure you get the same one from your pharmacist.
Why do I need to have some blood tests?
The first blood test is to check that it's safe for you to take valproate. Your liver must be healthy. After a few weeks, you
may need another blood test. This will tell your doctor if you are taking the right dose of valproate for you. You may only
need blood tests for the first six months of your treatment.
Is valproate safe to take?
It is usually safe to have valproate regularly as prescribed by your doctor, but it doesn’t suit everyone. Let your doctor know
if any of the following apply to you, as extra care may be needed:
a) if you are diabetic, have porphyria, SLE, or suffer from kidney or liver trouble or your family has a history of liver trouble;
b) if you are taking any other medication. This includes medicine from your pharmacist, such as aspirin or cimetidine
(‘Tagamet’);
c) if you are pregnant, breast feeding, or wish to become pregnant.
What is the usual dose of valproate?
The starting dose of sodium valproate (e.g. ‘Epilim’) is usually between 400mg to 600mg a day. The maintenance dose can
vary from 400mg to 2500mg a day. The maximum dose of sodium valproate is 2500mg a day.
For valproate semisodium (‘Depakote’), the starting dose is usually 250mg three times a day. The maintenance dose is
usually 1000mg to 2000mg a day.
How should I take valproate?
Look at the label on your medicine; it should have all the necessary instructions on it. Follow this advice carefully. If you
have any questions, speak to your doctor or pharmacist. Most medicines are now dispensed with an information leaflet for
you to read.
What should I do if I miss a dose?
Never change your dose without checking with your doctor. If you forget a dose, take it as soon as you remember, as long
as it is within a few hours of the usual time.
What will happen to me when I start taking valproate?
For most people with bipolar affective disorder highs and lows occur quite rarely. Valproate should make these highs and
lows less extreme or less frequent. So, it may take months or years to see the full beneficial effects of valproate. The best
way to know whether it is working for you is to compare your highs and low before and whilst taking it.
Unfortunately, you might get some side effects before your mood gets any better. Most of these side effects should go
away after a few weeks. Sometimes, the level of valproate in your body gets too high which can be dangerous. You need to
be able to spot the side effects that can mean a high level of valproate. Look at the table below. It tells you what to do if you
get any side effects. Not everyone will get the side effects shown. There are many other possible side effects. Ask your
pharmacist, doctor or nurse if you are worried about anything else that you think might be a side effect.
Side effect What is it? What should I do if it happens to me?
COMMON
GASTRIC IRRITATION
or NAUSEA
Feeling sick. You have an upset stomach. This
usually happens at the start of treatment.
Take your valproate with or after food. If it is bad,
contact your doctor. The slow-release tablets may
help.
UNCOMMON
INCREASE IN
APPETITE and
WEIGHT GAIN
Eating more and putting on weight. Avoid fatty foods like chocolate, crisps and fizzy
drinks. A diet full of vegetables and fibre will usually
help, as will physical activities such as walking. If it
becomes a problem or you are worried, ask to see a
dietician.
RARE
ATAXIA Being very unsteady on your feet. Your valproate dose may be too high. Contact your
doctor now.
CONFUSION Your mind is all mixed up. Your valproate dose may be too high. Contact your
doctor now.
DROWSINESS Feeling sleepy or sluggish. This usually happens
early in treatment and should go away.
Don't drive or use machinery. Ask your doctor if you
can take your valproate at a different time.
HAIR LOSS Some of your hair falls out and may seem thinner.
This stops after a while. It may regrow curly.
Discuss this with your doctor.
IMPAIRED LIVER
FUNCTION
Your liver is not working very well. You may feel
sleepy, be sick, lose your appetite and your skin
may look yellow.
Stop taking valproate and see your doctor as soon
as possible.
TREMOR Feeling shaky. This may be due to the dose of valproate you are
taking. Discuss this with your doctor.
VERY RARE
RASH A rash seen anywhere on the skin. Stop taking valproate and contact your doctor now.
THROMBOCYTOPENIA
and IMPAIRED
PLATELET FUNCTION
Low numbers of platelets in your blood. The
platelets that are there may not work very well.
You may bruise without reason and bleed easily.
Stop taking valproate and see your doctor now.
What about alcohol?
It is officially recommended that people taking valproate should not drink alcohol. This is because both valproate and alcohol can cause
drowsiness. If the two are taken at the same time, severe drowsiness can result. This can lead to falls or accidents. As well as this,
drinking alcohol often makes your mood unstable. Excessive drinking is especially likely to do this. Once people are used to taking
medication, they can sometimes drink alcohol in small amounts without any harm. Avoid alcohol altogether for the first one or two
months. After this, if you want a drink, try a glass of your normal drink and see how you feel. If this doesn’t make you feel drowsy, then
it is probably OK to drink small amounts. It pays to be very cautious because alcohol affects people in different ways, especially when
they are taking medication.
Don’t stop taking your medication because you fancy a drink at the weekend. If you do drink alcohol, drink only small amounts. Never
drink any alcohol and drive while on valproate. Discuss any concerns you may have with your pharmacist, doctor or nurse.
When I feel better, can I stop taking valproate?
No. If you stop taking valproate, your original symptoms may return. You should decide with your doctor when you can come off it. Most
people need to be on valproate for quite a long time, sometimes years. This is not usually harmful. Valproate is not addictive.
Remember, leaflets like this can only describe some of the effects of medication. You may find other
books or leaflets also useful. If you have access to the internet you may find a lot of information
there as well, but be careful, as internet based information is not always accurate.
2001 United Kingdom Psychiatric Pharmacy Group www.ukppg.org.uk
This leaflet is to help you understand about your medicine. It is not an official manufacturer's Patient Information Leaflet.
For more information call the UKPPG National Telephone Helpline, 11am to 5pm, Monday to Friday on 020 7919 2999 or
visit www.nmhct.nhs.uk/pharmacy
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