valproic acid
Valproic acid is an antiepileptic medication used to treat certain types of seizures in children and adults. It lessens seizures by balancing chemicals in the brain. Valproic acid is taken by mouth and is available as capsules and oral solution. Your provider will help determine the dose based on your body weight, symptoms and side effects, and blood work. Some common side effects of valproic acid include tremors, nausea, and headache. Though rare, this medication might also cause serious liver problems. Valproic acid can't be taken during pregnancy because it can cause serious birth defects.
What is Valproic acid?
What is Valproic acid used for?
How Valproic acid works
Valproic acid is an antiepileptic. The exact way it works to control seizures isn't well understood. But it's thought that valproic acid signals your brain to make more of a chemical called gamma-aminobutyric acid (GABA). GABA helps to lower the bursts of activity in your brain, which can help to prevent seizure episodes.
Drug facts
More on Valproic acid essentials
Side effects of Valproic acid
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Tremor (25-57%)
- Nausea (34-48%)
- Headache (up to 31%)
- Excess sleepiness (27-30%)
- Vomiting (23-27%)
- Feeling weak (21-27%)
- Dizziness (18-25%)
- Hair loss (up to 24%)
- Diarrhea (13-23%)
- Stomach pain (12-23%)
Please note: These side effects were reported by people who took divalproex (Depakote) to treat seizures in clinical studies. Divalproex (Depakote) turns into valproic acid once it's absorbed into the gut.
Less Common Side Effects
- Infection
- Double vision
- Trouble sleeping
- Changes in appetite
- Blurry vision
- Body aches, cough, and other flu-like symptoms
- Feeling nervous
- Fever
- Indigestion
Valproic acid serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Suicidal thoughts or behaviors
- Severe allergic reactions: fever, rash, extreme tiredness, body aches, mouth sores, blisters, trouble breathing
- Serious liver problems: nausea, vomiting, not feeling hungry, pain in the right side of the stomach, yellowing of the whites of the eyes or skin, dark-colored urine, light-colored stool
- Extremely high blood ammonia levels: fatigue, poor mental alertness, vomiting
- Inflamed pancreas: upper stomach pain, fever, nausea, vomiting
- Serious bleeds: bleeding that's difficult to stop, vomiting blood, blood in the urine or stool, "coffee-ground" stool, unusual bruising
- Extreme drop in body temperature: shivering, feeling tired, feeling confused, slurred speech, coma
- Extreme drowsiness
The following Valproic acid side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
More common
Black, tarry stools
bleeding gums
bloating or swelling of the face, arms, hands, lower legs, or feet
blood in the urine or stools
confusion
crying
delusions of persecution, mistrust, suspiciousness, or combativeness
difficult or labored breathing
dysphoria
false beliefs that cannot be changed by facts
false or unusual sense of well-being
feeling of unreality
general feeling of discomfort or illness
headache
hoarseness
joint pain
loss of appetite
lower back or side pain
mental depression
muscle aches and pains
nervousness
painful or difficult urination
pinpoint red spots on the skin
poor insight and judgment
problems with memory or speech
quick to react or overreact emotionally
rapid weight gain
rapidly changing moods
sense of detachment from self or body
shakiness in the legs, arms, hands, or feet
shivering
sleepiness or unusual drowsiness
sweating
tightness in the chest
tingling of the hands or feet
trembling or shaking of the hands or feet
trouble recognizing objects
trouble sleeping
trouble thinking and planning
trouble walking
unusual bleeding or bruising
unusual tiredness or weakness
unusual weight gain or loss
vomiting
Less common
Abnormal dreams
absence of or decrease in body movement
bloody nose
bloody or cloudy urine
blurred vision
burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
change in personality
change in walking and balance
changes in patterns and rhythms of speech
clumsiness or unsteadiness
cold sweats
dark urine
deep or fast breathing with dizziness
degenerative disease of the joint
difficulty with moving
discouragement
dizziness
dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
excessive muscle tone
fast, irregular, pounding, or racing heartbeat or pulse
fear
feeling of warmth or heat
feeling sad or empty
flushing or redness of the skin, especially on the face and neck
frequent urge to urinate
heavy non-menstrual vaginal bleeding
increased need to urinate
indigestion
irritability
lack of appetite
lack of coordination
large, flat, blue or purplish patches in the skin
leg cramps
lip smacking or puckering
loss of bladder control
loss of interest or pleasure
loss of strength or energy
multiple swollen and inflamed skin lesions
muscle pain or stiffness
muscle tension or tightness
normal menstrual bleeding occurring earlier, possibly lasting longer than expected
numbness of the feet, hands and around mouth
pains in the stomach, side, or abdomen, possibly radiating to the back
passing urine more often
pounding in the ears
puffing of the cheeks
rapid or worm-like movements of the tongue
rapid weight gain
restlessness
seeing, hearing, or feeling things that are not there
shakiness and unsteady walk
slurred speech
small red or purple spots on the skin
sweating
swollen joints
tiredness
trouble with concentrating
trouble with speaking
twitching
uncontrolled chewing movements
uncontrolled movements of the arms and legs
unsteadiness, trembling, or other problems with muscle control or coordination
vomiting of blood or material that looks like coffee grounds
yellow eyes or skin
Incidence not known
Aggression
bladder pain
blistering, peeling, loosening of the skin
blisters on the skin
bone pain, tenderness, or aching
chest discomfort
cloudy urine
decrease in height
decreased urine output
difficulty swallowing
feeling that others are watching you or controlling your behavior
feeling that others can hear your thoughts
feeling, seeing, or hearing things that are not there
increased sensitivity of the skin to sunlight
increased thirst
irritability
joint or muscle pain
loss of balance control
loss of consciousness
mask-like face
pain in the back, ribs, arms, or legs
pain or swelling in the arms or legs without any injury
puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
red skin lesions, often with a purple center
red, irritated eyes
redness or other discoloration of the skin
seizures
severe mood or mental changes
severe sunburn
shuffling walk
slow heartbeat
slowed movements
slurred speech
sores, ulcers, or white spots in the mouth or on the lips
stiffness of the arms and legs
swelling of the face, ankles, or hands
swollen or painful glands
tic-like (jerky) movements of the head, face, mouth, and neck
unusual behavior
Get emergency help immediately if any of the following symptoms of overdose occur:
Symptoms of overdose
Change in consciousness
fainting
loss of consciousness
slow or irregular heartbeat
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
More common
Belching
body aches or pain
change in vision
congestion
continuing ringing or buzzing or other unexplained noise in the ears
hair loss or thinning of the hair
hearing loss
impaired vision
lack or loss of strength
loss of memory
problems with memory
seeing double
tender, swollen glands in the neck
uncontrolled eye movements
voice changes
Less common
Absent, missed, or irregular menstrual periods
burning, dry, or itching eyes
change in taste or bad unusual or unpleasant (after) taste
coin-shaped lesions on the skin
cough producing mucus
cramps
dandruff
discharge or excessive tearing
excess air or gas in the stomach or bowels
feeling of constant movement of self or surroundings
full feeling
increased appetite
itching of the vagina or genital area
loss of bowel control
neck pain
oily skin
pain during sexual intercourse
pain or tenderness around the eyes and cheekbones
passing gas
rash with flat lesions or small raised lesions on the skin
redness or swelling in the ear
redness, pain, swelling of the eye, eyelid, or inner lining of the eyelid
redness, swelling, or soreness of the tongue
sensation of spinning
stiff neck
stopping of menstrual bleeding
thick, white vaginal discharge with no odor or with a mild odor
Incidence not known
Breast enlargement
changes in hair color or texture
discoloration of the fingernails or toenails
increased hair growth, especially on the face
unexpected or excess milk flow from the breasts
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
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Pros and cons of Valproic acid
Pros
- Available as a lower-cost generic
- Dose can be adjusted based on your response
- Available in capsules and liquid solution
- Can be used on its own or with other medications to control seizures
Cons
- Can’t take while pregnant
- Requires regular blood work and lab tests to make sure your liver is healthy
- Interacts with many medications, such as phenytoin (Dilantin)
- More likely to cause stomach irritations compared to divalproex (Depakote)
Pharmacist tips for Valproic acid
- You can typically take valproic acid with or without food. But if you get an upset stomach, taking this medication with food can help alleviate stomach side effects.
- If your dose of valproic acid is higher than 250 mg daily, you might need to take it as multiple smaller doses throughout the day.
- Swallow valproic acid oral capsules whole. Don't open or chew the capsules since it can irritate your mouth or throat. If you're unable to swallow pills, talk to your provider about switching to valproic acid oral solution.
- Use a medication measuring device to measure out your dose of valproic acid oral solution. Don't use a kitchen spoon, because it might not be accurate. If you don't have a medication measuring device, you can purchase one at the pharmacy or ask your pharmacist.
- If you want to stop treatment with valproic acid, talk with your provider. Don't stop taking valproic acid suddenly since it can raise your risk for seizures that won't stop. Your provider can help you stop this medication safely by lowering your dose slowly over time.
- Your provider might ask you to get blood tests done routinely while you’re taking valproic acid. This is so that they can watch out for your liver health. Tell your provider right away if you've symptoms of liver damage, such as upper right stomach pain, nausea, vomiting, no appetite, yellowing of the skin or whites of the eyes, swelling of your face, or dark urine. Risk for liver damage is the highest in the first 6 months of treatment.
- In some rare cases, valproic acid can cause high blood ammonia levels. Let your provider know if you experience symptoms of tiredness, trouble with focus or concentration, or vomiting.
- If you're able to become pregnant, make sure to use birth control, like condoms, while taking valproic acid. Don't take valproic acid if you're pregnant since it can cause harm to the unborn baby. If you're pregnant or thinking of getting pregnant during treatment, contact your provider right away. Your provider might prescribe you a different medication that's safer during pregnancy.
- Contact your provider if you experience symptoms of depression or worsening mood while taking valproic acid. There's a risk that this medication can worsen depression.
- Let your provider know if you're taking over-the-counter pain medications (e.g., aspirin) or if you're on blood thinners such as warfarin (Coumadin). These medications can interact with valproic acid and put you at a higher risk for bleeding or more side effects from valproic acid.
- Valproic acid can sometimes cause rash and other severe skin reactions. If you have a rash, skin pain, blisters, or skin peeling, talk with your provider right away.
- Avoid drinking alcohol while taking valproic acid. Doing so will not only raise your risk of liver problems, but it can worsen some of the side effects of valproic acid such as sleepiness and dizziness. In particular, valproic acid can cause extreme drowsiness in people over 65 years old, which can raise the risk of falling.
- Tell your provider if you're experiencing more drowsiness than usual. Your provider might start you at a lower dose of valproic acid.
Common questions about Valproic acid
Your provider will order blood work from time to time to check the valproic acid levels in your body. They might do this more regularly when you first start valproic acid or while you're changing your dose. The results from the blood work can tell your provider whether the valproic acid dose you're taking will work well to control your seizures and minimize your risk of serious side effects, such as liver problems. If the level of valproic acid is low in your blood, you might experience seizures more often. Talk with your provider if you've questions about your dose of valproic acid.
Valproic acid and divalproex (Depakote) are both antiepileptics used to treat certain types of seizures. Both medications are available by prescription from your provider; both have lower-cost generics available as well. They have similar chemical structures, so you shouldn't take both at the same time. In fact, divalproex (Depakote) gets broken down in your body to valproic acid. The American Academy of Neurology doesn't recommend one over another when it comes to controlling partial or absence seizures.
Valproic acid is considered a valproate product, or a form of valproate. Talk with your provider if you've questions about valproic acid or other valproate medications.
Though rare, valproic acid can cause serious liver damage. This is more common in the first 6 months of treatment. Your risk is higher if you've a history of liver problems, including liver problems caused by genetic conditions. In addition, children under 2 years old are also more likely to experience liver problems during treatment. To prevent liver damage, your provider will monitor your blood work during treatment to make sure this medication is safe for you. Consider limiting or stopping alcohol while taking valproic acid to prevent further damage to your liver. If you frequently feel sleepy, have upper right stomach pain, yellowing of the skin or eyes, or dark urine, talk with your provider right away.
Valproic acid can cause ammonia to build up in your body, which can cause changes in your ability to think. High levels of ammonia in the blood can lead to brain damage, which can be dangerous. If you've a history of metabolic disorders that raise ammonia levels (e.g., urea cycle disorders), your provider might switch you to a different medication that's safer for you. Don't take this medication with topiramate unless directed by your provider. Taking both medications can raise your risk of brain damage.
Valproic acid and lithium (Lithobid) aren't known to have serious interactions. Lithium is a mood stabilizer used to treat bipolar disorder, while valproic acid is used to control seizures. While they might not interact, both medications can cause similar side effects, such as tremors. Your provider will monitor your bloodwork for these medications closely to make sure they work well for you and to prevent serious side effects.
Yes, tremors are a common side effect of valproic acid. You're more likely to experience tremors if you're an older adult and when you first start this medication. To lower your risk of tremors, your provider will have you start with a lower dose of valproic acid and raise the dose slowly over time to better control your symptoms. It's best to avoid driving or doing activities that need a lot of hand coordination until you know how this medication affects you. If you have frequent or severe episodes of tremor, let your provider know. Your provider might adjust your dose of valproic acid or consider other medication options for you.
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Risks and warnings for Valproic acid
Valproic acid can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Liver problems
- Risk factors: Children under 2 years old | Taking multiple anti-seizure medications | Severe seizure problems | Certain genetic metabolic problems | Current or history of liver problems
Valproic acid can cause liver problems that can be life-threatening. These problems are more common in the first 6 months of treatment. Your risk is higher if you have a history of liver problems. If you have any of the risk factors listed above, please talk with your provider so they can decide whether valproic acid is a safe treatment for you.
Your provider will order blood tests before you start and while you're taking valproic acid to check your liver health. If you experience symptoms of liver problems, such as feeling sleepy, upper right stomach pain, yellowing of the skin or eyes, or dark urine, talk with your provider right away.
Serious birth defects
Don't take valproic acid if you're pregnant. Valproic acid can cause serious problems to unborn babies, such as neural tube defects, if taken by mothers during pregnancy. If you're able to become pregnant, your provider might recommend you to use a form of birth control or take folic acid while you're taking valproic acid. If you become pregnant while taking valproic acid, let your provider know right away. Don't stop taking this medication on your own since it might raise your risk of seizures. You’re also encouraged to enroll in the North American Antiepileptic Drug (NAAED) Pregnancy Registry. This registry monitors and collects information about your and your baby’s health. Learn more about this registry by calling 1-888-233-2334.
Serious pancreas problems
Though rare, people who took valproic acid have reported inflammation of the pancreas (pancreatitis). This can happen at any point during treatment with this medication. Some common symptoms of an inflamed pancreas are upper stomach pain, fever, nausea, and vomiting. If you start to feel any of these symptoms, contact your provider right away.
Suicidal behavior and thoughts
- Risk factors: History of depression | Taking antiepileptics
As with many other antiepileptics, valproic acid can raise the risk of suicidal thoughts or actions as early as 1 week after starting treatment. The risk is higher if you've had suicidal thoughts or actions in the past. Let your friends and family know to watch out for new or worsening signs of depression or other changes in mood or behavior. Call your provider right away if any suicidal thoughts or actions occur.
Lower blood cell counts
- Risk factors: Taking higher doses of valproic acid | Taking medications that lower blood cell counts
Though extremely rare, some people developed lower platelet count while taking valproic acid. This can put you at higher risk for bleeds. Your provider will typically require lab work before and while you're taking this medication to make sure it's safe for you. Let your provider know if you've symptoms of bleeding, such as abnormal bruising.
Higher ammonia level in blood
- Risk factors: History of metabolic disorders | Taking topiramate | Low body temperature
Valproic acid can cause ammonia to build up in your body. This can cause you to become more tired, unable to concentrate, or vomit. In some cases, you might also experience a drop in body temperature when your ammonia level is high. High levels of ammonia in the blood can lead to brain damage, which can be dangerous. Get medical attention right away if you notice any of these symptoms. Don't take valproic acid if you've been told that you have a history of metabolic disorders that raise ammonia levels (e.g., urea cycle disorders).
Severe skin and allergic reactions
Valproic acid can sometimes cause rash and other severe skin reactions. In some cases, these severe allergic reactions, such as drug reaction with eosinophilia and systemic symptoms (DRESS), have happened with or without a rash. Although these reactions are rare, they can cause organ failure or blood problems. Let your provider know if you experience these reactions because they'll need to stop valproic acid treatment and also talk with you about safer options to treat your condition. If you have a rash, blisters on your lips, skin peeling, skin pain, mouth sores, or high fever, get medical help immediately.
Excessive sleepiness in older adults
- Risk factors: People 65 years and older | History of kidney problems
Valproic acid can cause excessive sleepiness, especially in older adults. Some of these older adults might also end up eating or drinking less, which can lead to low fluids in the body and weight loss. If you're over the age of 65, your provider will adjust your dose more slowly to make sure these side effects don't happen. Let your provider know if you get too sleepy from valproic acid or if you're losing weight during treatment.
Interaction with other medications
Some medications can interfere with how your body gets rid of valproic acid. This can affect the amount of valproic acid in your body, how well it works, and the risk of side effects.
For example, taking valproic acid with carbapenem antibiotics can lower the amount of valproic acid in your body and potentially cause valproic acid to not work as well. On the other hand, taking valproic acid with aspirin can raise the amount of valproic acid in your body and potentially lead to more side effects. As a result, your provider will monitor your blood work closely when you take these medications together.
Likewise, valproic acid can also interfere with how your body gets rid of other medications and raise your risk of side effects from those medications. For example, taking valproic acid can raise the amount of lamotrigine (Lamictal) in your body. Taking a lower dose of lamotrigine (Lamictal) might help reduce your risk of serious side effects like rash.
For your safety, let your provider or pharmacist know what other medications you’re taking before and while taking valproic acid so they can help you check for interactions.
Valproic acid dosage
Typical dosage for Valproic acid
Focal impaired awareness seizure (people ages 10 years or older)
- Your provider will determine the dose based on your body weight. The typical starting dose ranges from 10 mg/kg to 15 mg/kg by mouth per day. Your provider will raise your dose weekly as needed to better control the seizures. The maximum daily dose is 60 mg/kg.
Absence seizure
- Your provider will determine the dose based on your body weight. The typical starting dose is 15 mg/kg by mouth per day. Your provider will raise your dose weekly as needed to better control the seizures. The maximum daily dose is 60 mg/kg.
Your dose might differ if you're an older adult, if you take rufinamide (Banzel), or if you've side effects from this medication.
Interactions between Valproic acid and other drugs
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Calcifediol
- Calcium Oxybate
- Cannabidiol
- Carvedilol
- Cisplatin
- Doripenem
- Ertapenem
- Estradiol
- Ethinyl Estradiol
- Imipenem
- Lamotrigine
- Lumateperone
- Magnesium Oxybate
- Meropenem
- Mestranol
- Orlistat
- Pexidartinib
- Potassium Oxybate
- Primidone
- Propofol
- Sodium Oxybate
- Vorinostat
- Warfarin
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Acyclovir
- Aspirin
- Betamipron
- Carbamazepine
- Cholestyramine
- Clomipramine
- Erythromycin
- Ethosuximide
- Felbamate
- Fosphenytoin
- Ginkgo
- Lopinavir
- Lorazepam
- Mefloquine
- Nimodipine
- Nortriptyline
- Olanzapine
- Oxcarbazepine
- Panipenem
- Phenobarbital
- Phenytoin
- Rifampin
- Rifapentine
- Risperidone
- Ritonavir
- Rufinamide
- Topiramate
- Valacyclovir
- Zidovudine
How much does Valproic acid cost?
$29.87
Valproic acid contraindications
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Valproic acid will not be safe for you to take.
- History of liver problems or certain liver diseases (e.g., urea cycle disorders)
- Have certain genetic disorders (e.g., Alpers-Huttenlocher Syndrome)
- Children under 2 years old at risk of certain genetic disorders (e.g., POLG (DNA polymerase gamma)) disorder)
- People who are pregnant or can become pregnant but aren't using contraception
What are alternatives to Valproic acid?
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