Post by sgriffit on Mar 11, 2015 6:33:40 GMT
Is the medication a typical/atypical antipsychotic? Is the medication an SSRI/SNRI antidepressant?
Sodium Valproate is a antipsychotic agent that can also be used to treat epilepsy and neuropathic pain. It is often used for mania when other medications are ineffective or inappropriate. Sodium valproate comes in: tablet, syrup or intravenous form. Pharmacological effects include:
Reduced release of excitatory amino acids
Increased gamma-aminobutyric acid transmission
Blockade of voltage-gated sodium channels
Modulation of dopaminergic and serotonergic transmission.
Sodium Valproate has a half life of 8-20 hours in most patients. It is metabolised in the liver.
Common Brand Names
Epilim
Valprease
Valpro
Normal Dose Range
Initially 600mg orally daily. Increasing by 200 mg per day at 3 day intervals until control is reached. Maximum 2500mg per day for tablet form.
400-800mg (up to 10mg/kg) IV over 3-5 minutes or by IV infusion, then 1-2mg/kg/hr (daily maximum 2.5g)
Common Side Effects
Nausea
Vomiting
Diarrhoea
Abdominal cramps
Increased appetite
Weight gain
Drowsiness
Sedation
Elevated liver enzymes
Rash
Pruritus
Confusion
Contraindications
Sodium Valproate should be avoided with patients who have liver disease or a family history of liver disease. Renal failure can lead to impaired protein binding and lead to the accumulation of metabolites. Lower does may be given to patients with renal failure.
Patients with a urea cycle disorder or porphyria should also avoid Sodium Valproate.
Drug interactions include:
Aspirin
Carbamazepine
Carbapenems
Lamotrigine
Olanzapine
Topiramate
Zidovudine
Special monitoring/Nursing care requirements
May take 2-6 weeks for optimal level to be reached
Liver function is assessed before starting therapy then monitored monthly for 6 months, then less frequently.
Blood counts and platelet counts should be monitored before and regularly throughout therapy and especially before surgery as bleeding time may be prolonged.
Not recommended for IM due to risk of tissue necrosis
Education requirements for patients/families/carers
Advised to take with or after food to reduce gastrointestinal adverse effects, but avoid taking with carbonated water
Patients should take regular dosage at least 3 times a day to avoid excessive fluctuations in serum and brain drug levels
Take with milk to avoid unpleasant taste
Care should be taken when using syrup in patients with diabetes because it contains 3.6g sucrose/5ml. Sugar free syrup is available as an alternative
Uncoated tablets may be crushed for easier administration
Normal syrup may be diluted but sugar free can not be diluted
Avoid using aspirin
Educate about possible weight gain
Patients should be advised to immediately report:
Any sudden brushing or bleeding
Any nausea, vomiting, abdominal pain or anorexia
Ongoing lethargy, changes in mental state or vomiting
Any signs of liver dysfunction (malaise, weakness, lethargy, facial oedema, anorexia, vomiting, abdominal pain, drowsiness, yellowing of skin or eye whites or darkened urine)
Sodium Valproate word.docx (486.83 KB)
Sodium Valproate is a antipsychotic agent that can also be used to treat epilepsy and neuropathic pain. It is often used for mania when other medications are ineffective or inappropriate. Sodium valproate comes in: tablet, syrup or intravenous form. Pharmacological effects include:
Reduced release of excitatory amino acids
Increased gamma-aminobutyric acid transmission
Blockade of voltage-gated sodium channels
Modulation of dopaminergic and serotonergic transmission.
Sodium Valproate has a half life of 8-20 hours in most patients. It is metabolised in the liver.
Common Brand Names
Epilim
Valprease
Valpro
Normal Dose Range
Initially 600mg orally daily. Increasing by 200 mg per day at 3 day intervals until control is reached. Maximum 2500mg per day for tablet form.
400-800mg (up to 10mg/kg) IV over 3-5 minutes or by IV infusion, then 1-2mg/kg/hr (daily maximum 2.5g)
Common Side Effects
Nausea
Vomiting
Diarrhoea
Abdominal cramps
Increased appetite
Weight gain
Drowsiness
Sedation
Elevated liver enzymes
Rash
Pruritus
Confusion
Contraindications
Sodium Valproate should be avoided with patients who have liver disease or a family history of liver disease. Renal failure can lead to impaired protein binding and lead to the accumulation of metabolites. Lower does may be given to patients with renal failure.
Patients with a urea cycle disorder or porphyria should also avoid Sodium Valproate.
Drug interactions include:
Aspirin
Carbamazepine
Carbapenems
Lamotrigine
Olanzapine
Topiramate
Zidovudine
Special monitoring/Nursing care requirements
May take 2-6 weeks for optimal level to be reached
Liver function is assessed before starting therapy then monitored monthly for 6 months, then less frequently.
Blood counts and platelet counts should be monitored before and regularly throughout therapy and especially before surgery as bleeding time may be prolonged.
Not recommended for IM due to risk of tissue necrosis
Education requirements for patients/families/carers
Advised to take with or after food to reduce gastrointestinal adverse effects, but avoid taking with carbonated water
Patients should take regular dosage at least 3 times a day to avoid excessive fluctuations in serum and brain drug levels
Take with milk to avoid unpleasant taste
Care should be taken when using syrup in patients with diabetes because it contains 3.6g sucrose/5ml. Sugar free syrup is available as an alternative
Uncoated tablets may be crushed for easier administration
Normal syrup may be diluted but sugar free can not be diluted
Avoid using aspirin
Educate about possible weight gain
Patients should be advised to immediately report:
Any sudden brushing or bleeding
Any nausea, vomiting, abdominal pain or anorexia
Ongoing lethargy, changes in mental state or vomiting
Any signs of liver dysfunction (malaise, weakness, lethargy, facial oedema, anorexia, vomiting, abdominal pain, drowsiness, yellowing of skin or eye whites or darkened urine)
Sodium Valproate word.docx (486.83 KB)