Valparin (Sodium Valproate / Valproic Acid)
Also sold as: Valparin, Encorate, Valance, Depakote, Convulex
Pregnancy
Cat X
Lactation
Caution
Schedule
H
Forms
Tablet 200mg, 500mg +3
Indications
- All seizure types — especially generalised epilepsy (absence, myoclonic, tonic-clonic) — broad spectrum
- Juvenile myoclonic epilepsy (JME) — first-line
- Bipolar disorder — acute mania and maintenance
- Migraine prophylaxis
- Status epilepticus (IV)
Adult Dosing
Epilepsy
Start 200-500 mg PO BD; increase by 200 mg/week to 1000-2000 mg/day
Chrono/CR preferred — better tolerability, fewer peaks. Therapeutic range: 50-100 mg/L
Bipolar mania
750-2000 mg/day in divided doses
Titrate to serum level 50-100 mg/L
Migraine prophylaxis
500-1000 mg/day
Minimum 3 months to assess effect
Status epilepticus (IV)
25-45 mg/kg IV over 5-10 min, then infusion 1-2 mg/kg/hour
Pediatric Dosing
CRITICAL: AVOID valproate in girls and women of childbearing potential whenever possible (teratogenicity, PCOS). In children <3 years: highest hepatotoxicity risk — avoid unless no alternative. Syrup for young children.
Renal Dose Adjustment
| CrCl / eGFR | Dose Adjustment |
|---|---|
| CKD | Free valproate levels rise (reduced protein binding) — measure free level; may need dose reduction |
Hepatic Adjustment
AVOID in significant hepatic disease — hepatotoxicity risk. CI in active liver disease.
Pregnancy & Lactation
Pregnancy: Category X
HIGHEST TERATOGENIC RISK of all anticonvulsants: neural tube defects (1-2%), cardiac/craniofacial defects, cognitive impairment (IQ reduction 6-9 points, autism risk 3×). CONTRAINDICATED in pregnancy for migraine and bipolar disorder. For epilepsy: use only if no safer alternative (levetiracetam, lamotrigine preferred); mandatory folic acid 5 mg/day, anomaly scan at 18-20 weeks. Classified X for psychiatric indications, D for refractory epilepsy (India MIMS Black Box Warning).
Lactation: Caution
Low levels in breast milk; generally considered compatible. Monitor infant for sedation, hepatotoxicity.
Top Drug Interactions
| Interacting Drug | Effect | Severity |
|---|---|---|
| Carbamazepine | Reduces valproate levels; increases toxic CBZ-epoxide metabolite | Major |
| Phenytoin | Displaces phenytoin from binding; complex interaction — free phenytoin rises | Major |
| Lamotrigine | Valproate DOUBLES lamotrigine levels — halve lamotrigine dose when adding valproate | Major |
| Aspirin (high dose) | Displaces valproate from protein binding — free level rises | Major |
| Meropenem / Carbapenems | Dramatically reduces valproate levels (up to 90%) — avoid combination; switch antibiotic | Major |
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Side Effects
Common
- Weight gain
- Hair loss (dose-dependent, usually reversible)
- Tremor
- Nausea
- Sedation
- Polycystic ovaries (females — irregular periods)
- Thrombocytopaenia
Serious / Discontinue If
- Hepatotoxicity — FATAL in children <3y (Reye-like syndrome, highest risk in first 6 months)
- Hyperammonaemic encephalopathy (without hepatitis — from ornithine transcarbamylase deficiency or valproate-induced)
- Pancreatitis
- Teratogenicity — see above
Contraindications
- Active liver disease / personal or family history of hepatic dysfunction
- Urea cycle disorders
- Pregnancy (migraine, bipolar — absolute; epilepsy — relative)
- Mitochondrial disorders (Alpers syndrome)
- Porphyria
Available Indian Brands
| Brand | Manufacturer | Price (approx) |
|---|---|---|
| Valparin 200mg | Torrent | 30 tab ₹48 |
| Encorate Chrono 500 | Sun Pharma | 30 tab ₹145 |
| Valance 500mg | Intas | 30 tab ₹138 |
| Valparin Chrono 300mg | Torrent | 30 tab ₹95 |
Monitoring Required
- Serum valproate level: therapeutic 50-100 mg/L (trough, drawn before morning dose)
- LFTs: baseline, then monthly × 6 months, then every 6 months
- CBC with platelets (thrombocytopaenia)
- Serum ammonia if confusion or encephalopathy
- Weight, menstrual cycles in females (PCOS)
- Pregnancy test and counselling for all women of childbearing age
Patient Counseling Points
- WOMEN: Do NOT get pregnant while on valproate without specialist discussion — very high birth defect risk
- Use effective contraception — inform gynaecologist about valproate
- DO NOT stop suddenly — severe seizure risk
- Carbapenems (imipenem, meropenem): reduce valproate levels — always inform treating doctor
- Report: jaundice, severe nausea/vomiting, unexplained confusion, unusual bleeding
- Hair loss is common and usually temporary — discuss with neurologist before stopping
Stop Googling drug references mid-consultation
EasyClinic auto-flags Valparin interactions, renal cutoffs, and pregnancy warnings the moment you write the prescription. Built-in safety net for every Indian doctor.
Clinically reviewed by: Dr. Vikram Sinha, DM (Neurology), Senior Neurologist
Last reviewed: 2026-04-01
References
- BNF — Valproate
- ILAE Epilepsy Treatment Guidelines
- MHRA Valproate Safety Review 2024
- IAP Epilepsy Guidelines 2024