Valproic acid or sodium valproate is also marketed under the name Depakine. It is an anticonvulsant with a broad spectrum of antiepileptic activity. Since its marketing in Europe in the 1960s, it is one of the most widely used antiepileptic drugs.
This drug was synthesized in 1882 and initially used as an organic solvent until its anti-epileptic properties were discovered. In the United States, it was marketed as a drug in 1978, since then demonstrating its effectiveness in all types of epileptic seizures.
So far, it has not been shown to make any type of seizure worse, unlike what happens with other anti-epileptic drugs, such as carbamazepine. Let’s dig deeper.
What condition can it be used for?
Valproic acid is indicated, according to its technical data sheet, for the treatment of generalized or partial epilepsies. More specifically, in the following cases:
- Generalized primary.
- Partial with basic or complex symptoms.
- Generalized or partial secondary.
- Mixed forms and secondary generalized epilepsies.
Likewise, it is also indicated for the treatment of manic episodes in bipolar disorder. For example, when lithium is contraindicated or not tolerated.
As said above, valproic acid has shown its effectiveness in all types of seizures. In addition, the possibility of administering it intravenously makes it particularly useful, especially in emergency situations. Here are some examples of situations where intravenous use is very helpful:
- Repeated epileptic attacks.
- Status epilepticus.
- Situations in which the patient cannot take the drug by mouth.
The mechanism of action of valproic acid
Valproic acid produces its effects mainly in the central nervous system. Its main mechanism of action is related to an increased inhibitory action of the neurotransmitter GABA or gamma-aminobutyric acid, although it is not fully understood either.
It has also been shown to inhibit enzymes that break down GABA and enhance the synthesis of this neurotransmitter by stimulating glutamic acid decarboxylase. Valproate also acts on other neurotransmitters, although to a lesser extent.
GABA is the main inhibitory neurotransmitter in the central nervous system. It is directly related to the regulation of muscle tone and involved in vision, sleep and motor control. Its function is to slow down brain activity.
Special warnings and precautions for use
Valproic acid has a high teratogenic potential and children exposed in utero to this drug are at high risk of birth defects and neurodevelopmental disorders. Thus, the doctor who prescribes this drug should assess the possibility of pregnancy in all patients.
It is necessary to make sure that the patient understands all the risks and is aware of the necessary contraceptive precautions. In all cases, a pregnancy test must be carried out before the start of treatment, as well as regular checks carried out during treatment. Faced with the slightest doubt, it is necessary to consult a specialist.
In summary, valproic acid is contraindicated during pregnancy, for both bipolar disorder and epilepsy. And as a preventive measure, it should not be used in women of childbearing age unless a number of conditions are present.
Side effects of valproic acid
The most common side effects are gastrointestinal effects, such as pain, nausea and diarrhea. Usually, they appear at the start of treatment and disappear during the first few days. Other side effects that may occur are:
- Extrapyramidal disorders.
- Memory failure.
- Urinary incontinence.
- Nail diseases.
- Weight gain.
- Liver injury.
In the event of the appearance of an adverse reaction, consult a specialist. Only he can assess its severity and consider possible changes in treatment.