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SODIUM VALPROATE

SIDE EFFECTS , INTERACTION

AND CONTRAINDICATION

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VPA: Common Side Effects

GI distress

Sedation

Liver transaminase elevation

Tremor

Hair loss

Weight gain-increased appetite

Thrombocytopenia (elders)

Teratogenic: neural tube, cranio-facial

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VPA: Less Common SE

Neutropenia

Coagulopathies,platelet Function

Endocrine abnormalitiesAmenorrhea, polycystic ovarian syndrome

Hypothyroidism

Hypocortisolemia

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VPA: Rare Dangerous SE

Idiosyncratic Hepatic Failure

Lethargy, anorexia, Nause and Vomiting, jaundice,

bleeding, edema

Risk: 10yo psychiatric patients

Acute Hemorrhagic Pancreatitis Bone Marrow Supression

If overdose: deep coma, pulmonary edema, death

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VPA: Interactions

Protein -bound drugs (ASA(Acetylsalicyclicacid-aspirin), phenobarbital, carbamazepine,warfarin, digoxin) -free-VPA

VPA (p450)levels of liver-metabolism drugs: TCAs, CBZ, phenobarbital, phenytoin, lamotrigine

CBZ(p450 inducer) lead VPA levels

p450 inhibitors (fluoxetine) leadVPA levels

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Contraindications

Pregnancy

Lactating Mothers

Bleeding Disorders Hepatic Disorders

Renal Diseases