• Basic Info
• Top Questions
• Clinical Info
• Interactions

Uses

Pending revision, the material in this section should be considered in light of more recently available information in the MEDWATCH notification at the beginning of this monograph.

Valproic acid (ionized form: valproate) is the active moiety for valproate sodium and divalproex sodium.

Absence (Petit Mal) Seizures

Alone or with other anticonvulsants (e.g., ethosuximide) as first-line therapy in the prophylactic management of simple and complex absence (petit mal) seizures.

In conjunction with other anticonvulsants in the management of multiple seizure types that include absence seizures.

Complex Partial Seizures

Alone or with other anticonvulsants (e.g., carbamazepine, phenytoin) as first-line therapy in the prophylactic management of complex partial seizures that occur either by themselves or in association with other seizure types.

Generalized Seizures

First-line therapy for generalized seizures, including primary generalized tonic-clonic†, primary generalized tonic-clonic absence†, myoclonic†, or atonic seizures†, especially when more than one type of generalized seizure is present.

Simple Partial Seizures

First-line therapy for the management of simple partial seizures†.

Status Epilepticus

Has been administered rectally† or by intragastric drip† with some success in the management of status epilepticus† refractory to IV diazepam.

A parenteral formulation of valproic acid has been studied and has been effective when administered IV† in the management of status epilepticus.

Bipolar Disorder

Alone or as a component of combination therapy (e.g., with lithium, antipsychotic agents [e.g., olanzapine], antidepressants, carbamazepine) for the treatment of acute manic or mixed episodes associated with bipolar disorder, with or without psychotic features.

American Psychiatric Association (APA) currently recommends combined therapy with valproic acid plus an antipsychotic agent or with lithium plus an antipsychotic agent as first-line drug therapy for the acute treatment of more severe manic or mixed episodes and monotherapy with one of these drugs for less severe episodes.

Valproic acid or lithium also is recommended for the initial acute treatment of rapid cycling.

Some clinicians recommend that valproic acid therapy be used in patients with bipolar disorder or schizoaffective disorder, bipolar type, who have responded inadequately to or have been unable to tolerate treatment with lithium salts or other therapy (e.g., carbamazepine), particularly if the patient displays residual manic symptoms, or in the presence of rapid-cycling, dysphoric mania or hypomania, associated neurologic abnormalities, or organic brain disorder.

Migraine Prophylaxis

Prophylaxis of migraine headache, with or without associated aura.

Because valproic acid may pose a hazard to the fetus (see Pregnancy under Cautions), it should be considered for women of childbearing potential only after this risk has been discussed thoroughly with the patient, and weighed against the potential benefits of treatment.

The US Headache Consortium states that valproic acid has medium to high efficacy for the prophylaxis of migraine headache.

No evidence of usefulness in the acute management† (i.e., abortive therapy) of migraine headache.

Schizophrenia

As an adjunct to antipsychotic drugs in the symptomatic management of schizophrenia† in patients who fail to respond sufficiently to an adequate trial of the antipsychotic agent alone.

APA and some clinicians state that anticonvulsant agents such as valproic acid and divalproex sodium may be useful adjuncts in schizophrenic patients with prominent mood lability or in those with agitated, aggressive, hostile, or violent behavior.

APA states that, with the exception of patients with schizophrenia whose illness has strong affective components, monotherapy with valproic acid or divalproex sodium has not been shown to be substantially effective in the long-term treatment of schizophrenia.