Any disorders in the functioning of the central nervous system require close attention to themselves. To combat such problems, a lot of medicines with different principles of exposure to the brain have been developed. One of them is Sodium Valproate.
Main components and release form
The main active ingredient of the drug - sodium salt of valproic acid - is a white crystalline fine powder, odorless. This is the form of release of the drug "Sodium valproate." Formula - C8H15NAO2. Easily soluble in alcohol and water.
The consumer is offered in tablets and plastic double-layer bags. The minimum possible volume in one package is 0.5 kg. Further in increasing order: 1, 2, 5, 10, 20, 25, 30, 40, 50, 65 kg.
Pharmacodynamics
Antiepileptic agent - the main function of the drug "sodium valproate". The mechanism of action is presumably based on an increase in the level of GABA (an amino acid that is the most important inhibitory neurotransmitter in humans and other mammals) in the central nervous system due to the inhibition of GABA transaminase and a decrease in the reuptake of this substance in brain tissues. The consequence of this process, apparently, is a decrease in the excitability and predisposition of the motor zones of the brain to the development of seizures.
Sodium valproate can have a tranquilizing effect, reduce the feeling of fear, improve the mood of patients, their mental state. In addition, it exhibits antiarrhythmic effects. The drug is highly effective in absences (a symptom of epilepsy, one of the varieties of an epileptic seizure) and temporal pseudoabsans, but has practically no effect on the condition of patients with the development of psychomotor seizures.
The scope of the drug
The main area of use of the drug "Sodium valproate" instructions for use regulates epilepsy, both in the form of monotherapy and in the combined treatment option. The drug is used in the presence of generalized seizures (polymorphic, large convulsive, etc.), partial and focal (motor, psychomotor, etc.). In addition, the drug is prescribed for convulsive syndrome, often accompanying organic diseases of the human nervous system, behavioral disorders, usually going hand in hand with epilepsy, with febrile seizures and nerve tics in pediatric patients.
Valproate sodium instruction is recommended for use in patients suffering from manic-depressive psychosis with bipolar course in cases where the disease cannot be treated with lithium preparations and other medications.
Who is contraindicated in using the medication?
Such complex drugs as antiepileptic drugs always have a certain list of contraindications for their use. You can not take the remedy for those who are hypersensitive to such a substance as valproic acid (sodium valproate, in fact, consists of its sodium salt). The reason for refusing to use is the presence in patients of functional abnormalities in the work of the liver and / or pancreas. Separately, it is worth highlighting hepatitis in this group of diseases (any forms - acute, chronic, drug, etc., including in the anamnesis of family members).
This drug is not prescribed for hemorrhagic diathesis, porphyria (in almost 99% of cases, a hereditary deviation, manifested in a violation of pigment metabolism with a high content of porphyrins in the blood and tissues).
Sodium valproate and pregnancy
The use of the drug in the first trimester of pregnancy is contraindicated. In the second and third trimester, the doctor will prescribe a prescription for the purchase of the sodium valproate medication only if the expected effect for the mother outweighs the potential risk to the child.
Patients should be notified that valproic acid is able to provoke the development of a number of congenital abnormalities in the fetus. In addition, this substance is excreted in breast milk (concentrations can reach 10% of the amount contained in the mother's plasma). Therefore, breastfeeding during therapy with medicines containing valproic acid in the composition is permissible only in cases of emergency.
As a universal recommendation to women of reproductive age, the use of reliable means or methods of contraception will be.
Unwanted effects
For patients undergoing treatment with Sodium Valproate, the instructions for use contain information about possible side effects from various systems and organs.
A possible reaction from the central nervous system may be tremor, changes in mood, behavior, impaired coordination, drowsiness, dizziness and headaches, irritability, motor anxiety and unusual arousal.
Possible reactions of the gastrointestinal tract are loss of appetite, dyspeptic symptoms, nausea, vomiting, diarrhea, small cramps in the intestine or stomach. Rarely can one hear about constipation or pancreatitis. In women, a menstrual cycle is possible. Often there are fluctuations in weight in one direction or another. The coagulation system can respond with thrombocytopenia, increasing the period of time required to stop bleeding. Dermatological abnormalities are possible in the form of alopecia (pathological hair loss), allergic - in the form of a skin rash.
Drug Administration
The dosage regimen for each patient is strictly individual. "Valproate sodium", the release form of which is in the form of a powder, is prescribed depending on body weight. The initial dosage for adult patients and children weighing more than 25 kg is 10-15 mg per kilogram of body weight (daily volume). If no side effects are observed, gradually (every 3-4 days) the dosage can be raised to 200 mg / day. until a noticeable clinical result is obtained. On average, the daily dosage can reach up to 30 mg / kg.
The medication treatment regimen is 2-3 times a day during meals.
The administration of sodium valproate intravenously is also practiced (the admissible volume of the drug is 400-800 mg) or drip (25 mg / kg over a period of 24, 36, 48 hours).
The maximum possible dose for therapy for adult patients and children with a body weight of more than 25 kg is 50 mg / kg per day. If for any reason it is necessary to increase it (dose), a prerequisite is monitoring the concentration of valproate in the blood plasma. If this indicator is more than 200 mg / l, the dosage should be reduced.
Excess dose
If for any reason there has been an excess of the permissible dose of the drug "Sodium valproate" (the Latin prescription is not understandable to all patients), a number of unambiguous symptoms are observed. The most common reactions are impaired coordination of movements and balance, lethargy, myasthenia gravis (pathologically rapid fatigue), hyporeflexia, nystagmus (involuntary eye fluctuations with a high frequency), myosis (narrowing of the pupil), heart block, coma.
The treatment is carried out in a hospital and consists of washing the stomach (it will be effective with enteral administration no later than 10-12 hours), providing osmotic diuresis (large volume of urine with a high concentration of active osmotic components) and supporting vital functions of the body. A good effect will give hemodialysis.
Interaction with other substances
When used in conjunction with other antipsychotics, antidepressants, MAO inhibitors, various derivatives of ethanol and benzodiazepine sodium, valproate will increase the inhibitory effect on the central nervous system. The combined use of the drug with hepatotoxic drugs, antiplatelet agents, anticoagulants, may provoke an increase in the influence of these substances.
Parallel administration of valproic acid and phenobarbital will lead to the displacement of the latter from communication with plasma proteins. The consequence is an increase in its (phenobarbital) concentration in blood plasma.
In general, sodium valproate can interact with a number of medications, so the doctor should notify you about the possible (or unacceptable) concomitant use of it with other medicines of the patient.
Special instructions
With great precautions, the medication is prescribed for patients suffering from diseases of the liver and pancreas (or having a history of them), children under the age of 3 years (the risk of developing hepatotoxicity is maximum, but decreases with increasing age). It should be borne in mind that the likelihood of negative effects from the liver increases with combined anticonvulsant therapy.
Patients taking "Valproate Sodium" and having pathological changes in blood should be very attentive to their state of health. Organic brain diseases, abnormalities in the functioning of the kidneys, hypoproteinemia are also quite serious risk factors for the development of negative consequences.
During the first half of the treatment with sodium valproate, it is important to constantly monitor the state of the blood coagulation system, liver function, and peripheral blood picture.
People taking any anticonvulsant medication need to start sodium valproate therapy gradually so as to achieve an effective dose after about 12-14 days. After which, previously taken anticonvulsant drugs should also be gradually withdrawn. If such preparations were not previously used by the patient, then an effective dose to obtain a clinical result should be achieved in a week.
Against the background of the use of the drug, care must be taken when driving vehicles and conducting work requiring concentration and a high speed of psychomotor reactions.
And the most important thing…
The basis for starting the use of any antiepileptic drug (sodium valproate is no exception) is the prescription of the attending physician.
Only a health worker is able to evaluate all factors and decide on the conduct of therapy with the use of a particular drug. Self-prescribing such serious medications for yourself is fraught with very, very negative consequences for your health condition - up to a coma and death.