Family doctor

USE: Epilepsy, mania

Sodium valproate (val-pro-ate) is used for epilepsy, including generalised and partial. Sodium valproate is also used for mania (a condition in which a person is very excited, agitated, talking quickly, sleeping little and with expansive ideas). Sodium valproate has been used for prevention of migraine, and pain conditions including trigeminal neuralgia. Usually the medicine is started as a low dose and gradually increased to get the best benefit.

Epilim comes in a cherry flavoured liquid or syrup, chewable tablets or enteric-coated tablets. The syrup contains regular sugar (sucrose) and artificial sweeteners, the liquid contains artificial sweeteners.

Cautions:

Sodium valproate must not be used in people with:

• Allergy to sodium valproate
• Current liver problems
• Family history of severe liver problems, especially from medicines
• Porphyria

A urine test for diabetes may show positive if using sodium valproate even if the person tested is not actually diabetic.

Special care needs to be taken with children - especially under 3 years of age, or those with brain disease, severe seizure disorders with mental retardation, congenital disorders (health problems since newborn), or on other epilepsy medicines.

A lower dose may be needed if kidneys are not working properly.

Side effects:

Like all medicines, sodium valproate can have side effects. Most people will not get these problems:

• Most commonly stomach effects can occur, especially when starting the medicine. The enteric-coated tablets are designed to stay intact in the stomach and not dissolve until they get to the intestine, so can reduce the stomach effects. The liquid, syrup or chewable tablets can be taken with meals.
• Liver effects - watch for weakness, lethargy (lying around not wanting to do anything), tiredness or drowsiness, generally feeling unwell, vomiting, stomach pain, not wanting to eat, jaundice (person looks yellow) - these symptoms would usually happen suddenly.
• Can prolong bleeding time - if bruising without a cause or bleeding occurs talk immediately to your doctor.
• Skin rash (talk to the doctor immediately).
• Sedation - usually is only temporary as the body gets used to the medicine. Some people will become more alert instead.
• Tremor or lack of coordination (occasionally with high dose).
• Increased appetite and increase in weight.

There are other less common side effects which are not listed above. If the dose is too high to start with or is increased too fast there can be a higher chance of side effects. Talk to your doctor if you think you may have any of these side effects or other symptoms.

Interactions:

Possible interactions include:

• Neuroleptics (e.g. chlorpromazine), antidepressants and benzodiazepines (e.g. diazepam, some sleeping tablets)
• Other epilepsy medicines - phenobarbitone, phenytoin, primidone, carbamazepine, lamotrigine
• Zidovudine
• Warfarin
• Felbamate
• Cimetidine (stomach medicine)
• Erythromycin (antibiotic)
• Mefloquine (malaria preventer)
• Cholestyramine (for cholesterol)
• Aspirin

Sodium valproate is not thought to interact with the oral contraceptive pill.

Patient information:

• Follow the instructions on the label of the medicine or as directed by your doctor.
• If the following symptoms occur, talk immediately to a doctor: weakness, lethargy (lying around not wanting to do anything), tiredness or drowsiness, vomiting, stomach pain, not wanting to eat, jaundice (person looks yellow). These symptoms could be from a liver problem caused by the medicine.
• Talk immediately to a doctor if you get a skin rash (and mention that you are taking this medicine).
• The tablets take on moisture from the air so it is important that they are left sealed in the foil until taken.
• The sodium valproate liquid should not be mixed with other fluid.
• If drowsy or less alert do not drive or operate machinery.
• If being prescribed other medicines or buying medicines from a pharmacy or supermarket check that they will not interfere with sodium valproate.
• Do not stop taking this medicine without your doctor's advice.