Depakine 200mg Sanofi medicine for epilepsy (40 tablets)

Dosage form Box of 40 tablets
Specifications Sodium Valproat
Ingredient Sanofi

Ingredient

Composition information	Content
Sodium Valproat	200mg

Uses

Indications

DECAKINE 200mg drug is indicated in the following cases:

Epilepsy: Treatment of different epilepsy.

Anti -seizures effects are used to treat animal seizures and epilepsy in humans.

Clinical and experimental studies on Valproat have hypothesized about two types of anti -seizures. The first impact is the direct pharmacological impact associated with the plasma and brain levels in the brain.

The second impact proved to be indirect impact and perhaps related to Valproat metabolites that still exist in the brain or with changes in neurotransmitters or direct effects on the cell membrane. The most widely accepted hypothesis is the theory of gamma-aminobutyric acid (GABA), and this concentration increases after using Valproat.

Valproot reduces the intermediate phase of sleep and increases sleep slowly.

pharmacokinetics

Different pharmacokinetics studies about Valproat shows the following:

Valproat's bioavailability, after drinking, reaches nearly 100%.

Most substances are allocated into the bloodstream and quickly talk to non -cell fluid. Valproat is also distributed into the cerebrospinal fluid and into the brain, the concentration of valproate in cerebrospinal fluid is closely related to the concentration of free drugs in serum.

The half -life is 15 - 17 hours.

Usually the minimum concentration of serum needed to achieve the effectiveness of treatment is 40 - 50mg/l, with amplitude between 40 and 100mg/l. If it is necessary to achieve this concentration, it is necessary to consider the expected benefits and the risk of adultery effects, especially the adverse effects depending on the dose. However, the concentrations maintained higher than 150mg/l require a dose reduction.

Stable plasma concentrations achieved within 3-4 days.

Valproat is very strong with plasma proteins. The connection with protein depends on the dose and saturation level.

Valproat is excreted mainly in urine after metabolism by glucuronide and beta-oxidation.

Valproat may be separated, but the hemorrhage only affects the freedom of Valproat (about 10%).

Contrasting with other anti -epileptic drugs, Valproat does not touch the enzymes of the cytochrome P450 metabolic system, so this drug does not promote the transformation of itself, or other drugs such as estrogen, progesterone and anticoagulants.

Before taking Depakine 200mg Sanofi medicine for epilepsy (40 tablets)

How to use

Drugs Depakine 200mg Used orally. Swallow the tablet with some water, do not chew or crush the pills. The dosage is divided into 2-3 times/day, preferably during meals.

Dosage

epilepsy

This type of preparation is not suitable for children under 6 years old (the risk of choking when taking medicine). There are other types of drugs (for example, oral solution) more appropriate.

Daily dose is determined depending on the age and weight of the patient, however, it is necessary to take into account the distinct sensitivity of each person for Valproat.

Adults

Dosage should start with 600mg/day and then increase gradually 200mg every 3 days until the disease controls. This is usually within the dose from 1000mg to 2000mg per day, ie 20 - 30mg/kg/day. Cases that do not control the disease with this dose, can increase the dose of up to 2500mg/day.

Children weighing over 20kg

The starting dose should be 400mg/day (regardless of weight) and then gradually increasing until the control of the disease, this usually is in the dose of 20 - 30mg/kg/day. Cases that do not control the disease with this dose, can increase the dosage up to 35mg/kg/day.

Children weighs under 20kg

Doser 20mg/kg/day, in severe cases, the dose can be increased, but only on the condition that the concentration of valproat can be monitored in the blood in these patients using the dose above 40mg/kg/day, it is necessary to monitor clinical blood and clinical biochemical parameters.

Elderly

Dose should be determined based on the control of seizures.

Heart

The recommended starting dose is 1000mg/day (20mg/kg body weight). Should quickly increase the dose to achieve the desired clinical effect with the lowest dose. The maintenance dose is recommended in the treatment of bipolar emotional disorders from 1000mg to 2000mg/day. The dose may be increased but not exceeding 3000mg/day. Dosage must be adjusted according to the clinical response of each patient. Preventive treatment should be set for each patient with the lowest dosage effectively. Take the medication regularly every day, do not change or stop using the drug suddenly without notice to the doctor.

Girls, adolescents, women of reproductive age and pregnant women

Depakine 200mg should be started to be started and monitored closely by the doctor who has experience in the treatment of epilepsy or bipolar disorder. This drug should only be used when other treatments are ineffective or the patient is not tolerated (see the special warning, pregnancy and breastfeeding), balancing benefits - the risk of the drug should be carefully assessed in each regular examination for patients.

It is best to prescribe depakine 200mg in the form of monomers and use the lowest dose effectively. If possible, use prolonged release to avoid increasing the peak concentration in plasma. The daily dose should be divided at least into 2 single doses.

Starting for treatment

If the patient has been previously treated with other anti -epileptic drugs, starting slowly with sodium valproot until the optimal dose is reached for about 2 weeks and then reducing the combined dose of treatment depends on the effectiveness of epilepsy control treatment.

If the patient has not taken any other anti -epileptic drugs, it is best to increase the dose of a ladder every 2-3 days until the optimal dose is about 1 week.

When needed, it is possible to treat sodium valproat combination with other anti -epileptic drugs but must start slowly.

Treatment time

Absolutely follow the dose and treatment time, especially not to stop treating without consulting the doctor.

What to do when overdose?

Common signs are coma, accompanied by reduced muscle tone, reflex reduction, pupils, respiratory decline, metabolic acidosis, and hypotension or circulatory/shock can die.

There was a death after a large dosage, but more favorable outcomes.

However, symptoms may change and diseases have been reported with very high levels of drugs in plasma. Cases of increased intracranial pressure lead to brain edema have been reported. When taken overdose, the sodium content in sodium valproate can increase sodium in the blood.

Handling cases of overdose at the hospital is to treat symptoms: stomach drums when it is still useful for up to 10 - 12 hours after overdose, and monitor respiratory - cardiovascular function. Using Naloxone can be successful in some special cases.

In case of overdose, hemorrhage or dialysis can be successful.

What to do when you forget a dose? However, if close to the next dose, skip the forgotten dose and take the next dose at the time as planned. Note that it should not be used double the prescribed dose.

Side Effects

When using Depakine 200mg, you may experience unwanted effects (ADR).

Very common (> 10%), common (> 1 and 0.1 and 0.01 and

birth defects and development disorders (see the part of pregnancy and nursing period).

Blood disorders and lymphatic systems

Common: Anemia, thrombocytopenia (see the cautious part when used).

Uncommon: Demonstration of the whole blood cell line, leukopenia.

Rare: bone marrow failure, including simple property of red blood cells, granulocytes, large red blood cell anemia, large pathology.

Exploration tests

Rare: Reduce coagulation factors (at least tired), abnormal blood clotting tests (such as prolongrombin period, extend the partial activity time of thromboplastin, extend the thrombin period, extend the INR) (see the cautious part when used and pregnancy and breastfeeding), Biotin deficiency/ enzyme deficiency.

Nervous system disorders

Very common: vibration.

Common: Periodic disorders, stunning state, sleeping, convulsions, memory loss, headache, eyeball, dizziness may occur a few minutes after intravenous injection and all for a few minutes.

Uncommon: coma, brainstorming, sleeping (see below), Parkinson's recovery, loss of air conditioning, paresthesia.

Rarely: dementia is accompanied by recovery brain atrophy, cognitive disorders.

Stunning state and sleepy sleep that sometimes leads to a fleeting coma/brain disease, which can be separated or accompanied by an increase in the frequency of convulsions during treatment and these symptoms decreased when stopped or reduced the dose of drugs. These cases are very common in combination treatment (especially with phenobarbital or with topiramat) or after increasing the sudden Valproat dose.

Disorders of ears and snails

Common: deafness.

Disorders in the respiratory system, mediastinum, chest

Uncommon: pleural effusion.

Disorders in the gastrointestinal tract

Very common: nausea.

Common: vomiting, dental disorders (mainly gum hyperplasia), stomatitis, epigastric pain, diarrhea often occur when starting to treat, these evidence usually go away within a few days even though non -stop drugs. Seeing after intravenous injection for a few minutes, and also all over the next few minutes.

Uncommon: pancreatitis, sometimes deadly (see special warnings).

Disorders of kidney and urinary tract

Less: kidney failure.

Rare: Environmental Birth, interstitial nephritis, fanconi syndrome is likely to be close (a nearby renal tubular function, leading to urination, protein, phosphate and urine Uric) but unknown impact.

Disorders of skin and tissue

Common: increasing sensitivity, transient hair loss or not related to the drug.

Uncommon: microchips, rash, hair disorders (such as abnormal hair structure, hair color change, abnormal hair growth).

Rare: Skin poisoning necrosis, Stevens Johnson syndrome, diverse roses, rash syndrome due to drugs with eulogy and systemic symptoms.

Disorders of skeletal muscle and connective tissue

Uncommon: reducing bone mineral density, reducing bones, osteoporosis and fractures in long -term treatment patients with Depakine 200mg mechanism that Depakine 200mg affects the metabolism of unknown bone.

Rare: Lupus erythematosus system (see the cautious part when used), Demonstration (see the cautious part when used).

Endocrine disorders

Uncommon: Inappropriate syndrome of anti -diuretic hormone syndrome, androgen (hairy, male, acne, male -style baldness or Androgen increased).

Rare: Reducing thyroid function (see the part of pregnancy and lactation).

Nutrition and metabolic disorders

Common: reducing blood sodium, weight gain.

Weight gain should be carefully monitored because it is a risk factor for polycystic ovary syndrome (see carefully when used)

Rare: increased blood ammonia (see the cautious part when used), obesity.

Cases of hyper ammonia hyperactive and medium level not accompanied by changes in liver function tests that may occur, fleeting and without any treatment. Hyperoma hypernamia is accompanied by reported neurological symptoms, in these cases, it is necessary to consider to conduct other exploration tests.

benign, malignant, non -identical hyperthesis disorders (including cysts, polyps)

Rare: Bone marrow dysplasia.

vascular disorders

Common: Bleeding (see the cautious part when used and the pregnancy and breastfeeding period).

Less: vasculitis.

Disorders in the liver - bile

Common: liver damage (see special warning section).

Disorders in the mammary gland and genital system

Common

Menstrual disorders.

Less: Menstrual loss.

Rare: infertility in men, polycystic ovaries.

Mental disorders

Common: Confusion, hallucinations, aggression, agitation, attention disorders.

Rare: abnormal behavior, increased activity due to mental mental, learning disorders

Instructions on how to handle ADR

When experiencing side effects of the drug, it is necessary to stop using and notify the doctor or go to the nearest medical facility for timely treatment.

Warnings

Before using the drug you need to read the instructions carefully and refer to the information below.

Contraindicated

DEMAKINE 200MG DEPARTMENT OF CONCLUSION in the following cases:

allergies to sodium valproat or any ingredients of the drug.

acute or chronic hepatitis.

Personal history or families with severe liver disease, especially when related to drugs.

Porphyria liver (genetic disease associated with the abnormal creation of pigments called porphyrin).

History of liver disease or severe dysfunction of pancreatic or liver dysfunction.

Urea metabolic cycle disorders.

Patients who know or suspect have mitochondria.

Be cautious when using

Special Warning

Must be careful when taking Depakine 200mg

Very rarely occur, but Depakine 200mg can cause liver damage (hepatitis) or pancreatic (pancreatitis) that is critical to the patient's life.

The doctor will give blood tests to regularly monitor liver function, especially in the first 6 months of treatment.

report immediately to the doctor when the following signs appear:

Sudden fatigue, anorexia, exhaustion, sleep, drowsiness.

Vomiting many times, epigastric pain or abdominal pain, jaundice or eyes.

Reappearing seizures, despite being properly treated.

Severe liver damage

Frequency meets

Very rarely encountered and reported, severe liver damage is sometimes fatal. Experience shows that a group of patients at risk, especially in cases of treatment of epilepsy drugs, are children and children under 3 years old have severe seizures, especially with brain damage, mental retardation or degenerative disease or congenital metabolic disorders.

After 3 years of age, this risk is significantly reduced and increasingly decreasing with age. In most cases, severe liver lesions occur in the first 6 months of treatment.

Signs of suggestions

Early diagnosis is mainly based on clinical symptoms. Specifically, attention should be paid to the conditions that may be ahead of the following jaundice symptoms or yellow eyes, especially in a group of patients at risk:

There are no specific symptoms, often sudden onset, such as fatigue, anorexia, sleep, drowsiness, sometimes accompanied by vomiting and abdominal pain.

Relapse of seizures in epilepsy patients.

Patients (or relatives of children) must be instructed to notify the doctor when these signs occur. The exploration test must be conducted immediately including clinical examination and subclinical testing for liver function assessment.

Discover

Must perform liver function tests before treatment and then periodically in the first 6 months of treatment. Among the usual tests, tests reflect protein synthesis, especially prothrombin ratio will be most related.

Confirmation of abnormal low prothrombin ratio, especially when accompanied by biochemical abnormalities (significantly reduced fibrinogen and blood clotting factors, increased bilirubin levels and increased transaminase) requires the stop treatment of Depakine 200mg. Due to being cautious and in case of use at the same time, it is necessary to stop using Salicylate drugs because of the same drug transformation path.

Pancreatitis

Very rarely occur, but severe pancreatitis, which can be fatal, has been reported. Children with young age are at risk, but this risk decreases with increased age. Other risk factors may be severe, neurological seizures, or anti -convulsions treatment. Hepatitis with pancreatitis increases the risk of death. Patients with acute abdominal pain must be examined immediately. In the case of pancreatitis, it is necessary to stop treating with Valproat.

Girls, adolescents, women of reproductive age and pregnant women

Do not use depakine 200mg in girls, adolescents, women of reproductive age and pregnant women unless other treatments are ineffective or patients do not tolerate drugs because Valproat is more likely to cause teratogenic and the risk of developing disorders in children who have been exposed to Valproat since she was still in the womb.

Doctors must re -evaluate the benefits and risks of the drug during each periodic examination for patients, when the patient is up to puberty, and re -assessment as soon as a woman of reproductive age is treated with Valproat, she has a pregnancy or just pregnant plan.

Women of reproductive age are required to use effective contraception during treatment. Doctors need to notify patients with risks related to the use of Depakine 200mg during pregnancy (see the part of pregnancy and breastfeeding).

Doctors prescribed to make sure that the patient is provided with sufficient information about the risk when using this drug. This information can be transferred to patients in the form of pocket documents for patients to help female patients better understand this risk. The prescribed doctor must also ensure that this patient is properly informed and signed on the sample to confirm understanding and agreeing to treat.

Specifically, the prescribed doctor must make sure the patient understands:

Characteristics and importance of the risk of exposure to drugs during pregnancy, especially the risk of teratogenicity and the risk of fetal development disorders.

The need for effective contraception.

The need for periodic re -examination. The need to consult a doctor as soon as the female patient thinks she is pregnant or suspected of being pregnant.

Pregnant women who plan to try to switch to appropriate alternative treatments before conception, if possible (see the pregnancy and breastfeeding period).

Should only continue treatment with Valproot after re -assessing the risk - the benefits of the drug because a doctor has experience in treating epilepsy or bipolar disorder.

Having an idea or an attempt to commit suicide

The situation of suicidal ideas or calculation has been reported in patients using epilepsy drugs in some indications. An analysis of randomized clinical tests with placebo for epilepsy drugs also shows a slight increase in the risk of suicide or suicidal calculation. This mechanism of action is not well known.

Therefore, patients need to be monitored with signs of suicide ideas or attempts and need to seek medical assistance immediately if there are signs of ideas or suicidal calculations.

Carbapenem antibiotics

Simultaneously anti -sodium valproat and carbapenem antibiotics (see drug interactions).

Patients who know or suspect mitochondria

Valproat can activate or worsen the clinical symptoms in the potential diseases of the mitochondria caused by DNA mutations in the mitochondria as well as in the regulation of the polymerase Y (Polg) enzyme in the mitochondria coding for the nucleus. Specifically, acute liver failure and death associated with high proportion of Valproat treatment in patients with genetic neurological metabolism syndrome due to mutations in the mitochondria (for example, Alpers - Hottenlocher syndrome).

Polg -related disorders must be suspected in patients with family history or symptoms that suggest that the disease is related to Polg, including but not limited to uninfected brain disease, difficult -to -treat epilepsy (local, muscle shock), epilepsy status, mental stagnation, mental mental illness, axon disease of movement nerves - sensory organs, regulation of musculoskeletal Million seal in the occipital area. POLG mutation tests must be performed depending on current clinical practice to evaluate the diagnosis of the above disorders (see the contraindication section).

Testing for liver function before starting treatment (see the contraindications), and periodically monitoring in the first 6 months of treatment in patients at risk (see special warning section). As with most epilepsy medications, it is possible to record a slight increase in liver enzymes, especially at the beginning of the drug treatment, these signs are separate and transient. In these patients recommend additional biochemical tests (including prothrombin ratio), it is necessary to consider adjusting the dose accordingly and restoring tests when necessary.

Blood tests (blood formula, including platelet counting, bleeding time) are advised before starting treatment or before surgery, or in cases of bruises or spontaneous bleeding (see unwanted effects).

Although immune disorders are recorded as an exception when using Depakine 200mg, the treatment with Depakine 200mg must have superior benefits compared to this risk in patients with systemic lupus.

When suspected there is an enzyme deficiency in the urea cycle, the testing tests must be performed before treatment with Valproat because of the risk of hyper ammonia blood (see the contraindication section).

Patients must be warned of the risk of weight gain in the beginning of treatment and need to apply appropriate strategies to minimize this risk (see side effects). Patients with a deficiency of Carnitin Palmitoyl Transferase enzyme (CPT) Type II must be warned about the risk of larger muscle prize when taking medicine containing Valproat.

Do not use alcoholic drinks during treatment with Depakine 200mg.

For children: Valproat therapy should be used for children under 3 years old, but potential benefits must be more prominent than the risk of liver and pancreatic damage in the beginning of treatment (see special warning section). Simultaneous use with salicylate to avoid children under 3 years of age due to the risk of liver toxicity.

For people with kidney failure: It is necessary to reduce the dose. When tracking of plasma concentrations may be wrong, the adjustment of the dose depending on the clinical evaluation monitor.

The ability to drive and operate machinery

Depakine 200mg can cause drowsiness, especially when used with other epilepsy medications or drugs that can increase drowsiness.

If you've ever experienced this effect or your illness is not well controlled and you continue to have seizures, then you must not drive or operate machines.

Pregnancy

Risks related to seizures

During pregnancy, spastic - convulsions or epilepsy status causes lack of oxygen supply in the mother may have a special risk of death for both mother or fetus.

Risks related to depakine 200mg

On experimental animals: The biomedical impact has been confirmed in rats and rabbits.

congenital deformity

On humans: The available data suggests an increase in the proportion of severe or mild deformities, specifically including neural spinal defects, skull -face defects, limbs, cardiovascular deformities, low urinary tract deformities and abnormalities in other parts of children born from mothers who are treated by Valproat, compared to some other epilepsy drugs.

Data obtained from a gross analysis (including the data source of the set of books and pure studies) has shown that 10.73% of children with mothers with epilepsy use Valproot single therapy during congenital malformations (95% trust range: 8.16 - 13.29). The risk of this severe deformity is greater than that of normal populations (about 2-3%deformities).

The risk of deformities depends on the dose but the lower the dose level is not yet shown to be at risk. The data obtained from a gross analysis (included from the set of data books and from the pure studies) has shown that 10.73% of children with mothers with epilepsy use Valproat single -treatment treatment during congenital pregnancy (95% reliability: 8.16 - 13.29). The risk of this severe deformity is greater than that of normal populations (with a 2-3%deformity ratio). The risk of deformities depends on the dose but the lower the dose level is not yet proven to be at risk.

Development disorders

The existing data indicates that Valproat exposure can lead to a disadvantage of mental and physical development of children exposed. This risk depends on the dose but the lower dose is still not excluded. The exact period of time during pregnancy is affected by this risk has not been determined and the risk of the risk during pregnancy is not excluded.

Children's studies at kindergarten age have exposed to Valproat when they are fetuses in the womb have shown that 30-40% of children with developmental retardation in the beginning such as slow speech and slow walking, slow cognitive ability, language ability (reading and understanding) are poor and have memory problems.

Smart index (IQ) is measured on children of school age (6 years old) with Valproat exposure since the fetus in the mother's womb is 7-10 points lower than the group of children with exposure to other epilepsy drugs. Although it is impossible to rule out the role of infection factors, there is evidence on children exposed to Valproot showing that the risk of intellectual loss in children can be independent of the mother's IQ.

Data on long -term consequences is limited.

There are data indicating that children with Valproat exposure since they were fetuses in the womb increased the risk of autism disorders (estimated to increase about 3-5 times), including childhood autism. The data is limited so far suggesting that children with Valproat exposure since they were fetus in the womb were more likely to suffer from symptoms of attention hyperactivity disorder (ADHD).

The use of valproat in the form of single therapy or multiple therapy is related to some abnormal outcomes during pregnancy. The existing data shows that the risk of abnormalities during pregnancy when using multi -therapies regimens of epilepsy drugs includes higher Valproat than when using single treatment with Valproat.

Do not use Depakine 200mg in girls, adolescents, women of reproductive age and pregnant women if not really necessary (that is, when other treatments are ineffective or intolerant). This assessment must be done before the first prescription with Depakine 200mg or when a woman's reproductive age has the potential to treat with Depakine 200mg planning to get pregnant. Women of reproductive age need to use effective contraceptive measures during treatment.

Women who have reproductive age must be informed about the benefits and risks of using ValProat during pregnancy.

If women plan to become pregnant or pregnant, Depakine 200mg treatment must be re -evaluated with any indications:

With the indication of bipolar disorder, it is necessary to consider terminating treatment with Depakine 200mg.

With seizure indications, Valproat treatment is not interrupted without reassessing benefits/risk ratios. If it is necessary to carefully evaluate the benefits and the risk of further and continue to treat Depakine 200mg during pregnancy, then recommend using the drug by dividing it into the doses of the day at the lowest doses effectively. The use of prolonged release may be more suitable than other forms of preparation.

In addition, if appropriate, folat must be added at the appropriate dose (5mg/day) before pregnancy because this supplement may minimize the risk of neural spine defects. However, there is not enough evidence to say that this addition can help prevent the birth defects due to Valproot exposure.

It is necessary to start specialized monitoring prenatal to detect the occurrence of neurotransmitter defects or other deformities.

Breastfeeding period

Valproat is excreted in breast milk with a concentration of 1 - 10% compared to the mother's plasma concentrations. Based on literature and clinical experience, breastfeeding must be considered. Blood disorders have also been reported on children whose mothers are being treated with Valproat (see side effects).

The decision to stop breastfeeding or stop treatment with Valproat should be considered based on the benefit of breastfeeding and the benefits of the mother's treatment.

In any case, never stop treating epilepsy without a doctor's consent.

Drug interaction

The impact of valproot on other drugs

Sedative, inhibitors, antidepressants and benzodiazepin drugs: Depakine 200mg may increase the effects of these drugs, so clinical monitoring and dosage adjustment accordingly.

lithium

Depakine 200mg does not affect lithium concentration in serum.

Phenobarbital

Depakine 200mg increases serum phenobarbital concentration (due to inhibiting phenobarbital abuse in the liver) and sedative effects occur, especially in children. Therefore, clinical monitoring is needed in the first 15 days if there is a combination treatment, and the phenobarbital dose must be reduced immediately if the sedative effect occurs, the monitoring of the phenobarbital concentration in plasma will be decided accordingly.

Primidon

Depakine 200mg increases the plasma primary levels and increases the side effects due to this drug (such as sedative effects), these signs are terminated when long -term treatment. It is necessary to monitor clinically especially when starting with coordination treatment and adjusting dose accordingly.

phenytoin

Depakine 200mg reduces the total concentration of phenytoin in plasma. In addition, Depakine 200mg increases the free phenytoin and may occur overdose symptoms (Valproic acid replaces phenytoin plasma proteins and reduces phenytoin regression in the liver). Therefore, clinical monitoring and free phenytoin must be assessed when there is a phenytoin concentration in plasma.

carbamazepin

Clinical toxicity has been reported when using Valproat at the same time as carbamazepine, Valproot may increase the toxicity of carbamazepin. It is necessary to monitor clinically especially when starting with coordination treatment and adjusting dose accordingly.

lamotrigin

Depakine 200mg reduces Lamotrigin metabolism and increases Lamotrigin's selling time by nearly twice. This drug interaction can increase the toxicity of Lamotrigin, especially the heavy rash in the skin. The most clinical monitoring is needed when starting with coordination treatment and adjusting the dose (reducing the dose of lamotrigin) accordingly.

zidovudin

Valproat may increase zidovudine levels in plasma and increase the toxicity of zidovudin.

felbamat

Valproic acid can reduce the average clearance of Felbamat by up to 16%.

olanzapin

Valproic acid can reduce olanzapin levels in plasma.

rufinamid

Valproic acid may increase the level of plasma rufinamids, this increase depends on the concentration of Valproic acid. Must be cautious, especially in children, when this impact will be more than the common population.

The impact of other drugs on Valproat

Epilepsy medications have an enzyme effect (including phenytoin, phenobarbital, carbamazepine) that reduce the level of serum valproic acid. The dose must be adjusted depending on the clinical response and the blood concentration in the blood in case of coordination treatment.

On the other hand, combining Felbamat and Valpropat reduces Valproic acid clearance from 22-50%, resulting in increased Valproic acid levels in plasma. The dosage of Valproat used must be monitored.

Mefloquin increases Valproic acid metabolism and has a seizure effect, so when combined treatment can occur in seizures.

In case of using Valproat at the same time with high protein -attached drugs (aspirin), the level of valproic acid levels in the free body may increase.

Strictly monitor prothrombin ratio in case of anticoagulant drugs dependent on vitamin K.

Serum valert acid levels may increase (as a result of a decrease in metabolism in the liver) in case of use at the same time as cimetidine or erythromycin.

Carbapenem drugs (Panipenem, Meropenem, Imipenem ...) have reported a reduction of valproic acid levels in the blood when used at the same time as carbapenem, down to 60 - 100% of valproic acid levels for 2 days, sometimes accompanied by convulsions. Due to the rapid onset and the degree of decrease, it is necessary to avoid using carbapenem in patients who have been stably treated with Valproic acid. If the use of carbapenem drugs is not avoided, the blood level must be closely monitored.

Rifampicin can reduce the level of valproic acid in the blood, thereby losing the treatment effect. Therefore, it may be necessary to adjust the valpress dose when used at the same time as Rifampicin.

Protease inhibitors

When using simultaneously protease inhibitors such as Lopinavir, Ritonavir reduces plasma valproat levels.

cholestyramin

When using simultaneously cholestyramin reduces plasma valproat levels.

Other drug interactions

Use Valproat at the same time with Topiramat or Acetazolamid may come with enhancement or hyperioma in the blood. Those patients who treat the combination of these two drugs must be closely monitored with signs and symptoms of hyper ammonia in the blood.

quetiapin

Use at the same time with Valproat may increase the risk of reducing white blood cells.

Valproat usually does not have an enzyme -touch effect, so Valproat does not reduce the effectiveness of the oestroprogestative drugs in women who are using hormones.

inform the doctor that all the medications you or your child are using or just used, including those without prescription medications.

Storage

Store Depakine 200mg at a temperature below 30 ° C, avoid moisture.

Leave the medicine out of the vision and reach of children.

Do not use the drug beyond the permitted time limit is indicated outside the drug box.

Do not remove drugs in wastewater or family trash, ask the pharmacist how to cancel unused drugs. This will contribute to environmental protection.

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