Bipolar disorder is known to affect around 2.8 percent of the US population, while 1.2% of the population are known to experience seizures. Various medications with anti-manic properties, and neuroprotective properties are presently used to treat the conditions. Valproic acid is one among the different anticonvulsant medications that are considered as effective, and used for treating complex partial seizures and absence seizures that are both simple and complex in nature. Subsequent sections offer a detailed view of the anticonvulsant including possible valproic acid side effects to help users prevent and mitigate possible undesirable effects.
Overview of valproic acid
In use for more than four decades since FDA approval, valproic acid is essentially a fatty acid derivative and was initially used as an organic solvent before its anticonvulsant properties were identified or discovered. Pursuant to this discovery, it has been used as a medication for treating patients with bipolar disorder, and for managing seizures. Also known as valproate, properties attributed to it include anti-proliferative and anti-migraine. It is presently under study and clinical trials to determine its efficacy as part of a treatment regimen to treat certain types of cancer.
It is typically prescribed for treating/managing complex partial seizures, simple/complex absence seizures. The compound is either used as a single drug for the above conditions, or it is used as a part of combination treatment to support the primary treatment. It is also used as preventive medication for migraine headaches. Other conditions managed with valproic acid include mania that is associated with bipolar disorder. In addition to the above, the medication is also used off-label to treat acute bipolar depression, and for emergency treatment of status epilepticus.
Mechanism of action of the anticonvulsant
The medication is known to cause a sequence of actions wherein GABA (neurotransmitter) metabolism is reduced and certain actions are inhibited through indirect actions on GABA. While the exact mechanisms of action are yet to be determined fully, the actions of the medication on certain pathways, are known to help deliver outcomes on conditions such as epilepsy, bipolar disorder and migraine headaches. It is also known to have an effect on fatty acid metabolism, and this is in turn brings about the antiepileptic action attributed to the drug. The effect of valproic acid on migraine is attributed to the reduction in inflammatory prostaglandins brought about by certain inhibitory actions. Other medications that are used for migraine headaches, such as NSAIDs are also known to have a similar effect and mechanism of action, and this helps draw a parallel between the two. Other actions or outcomes are attributed to the neuroprotective effects of the medication.
General precautions to be followed when on the medication
To prevent undesirable effects, it is essential that patients and caregivers follow certain precautions. For instance, caregivers and family members with children on the medications are to closely monitor the health of the child. It is also essential to periodically carry out tests on blood and urine samples to determine if the medication is causing any undesirable effects. Pregnant women and women planning a pregnancy are to be aware of the possible effects of the medication.
Some of the probable effects that may occur, especially as a result of use of the medication during the initial stages of pregnancy include problems in the brain or the face. The child may develop heart complications, blood vessel problems, apart from various issues in the arms or legs. There is every possibility of the intelligence levels or mental abilities of the child being impacted. Women on the medication are to practice safe sexual practices and rely on effective birth control methods. One of the precautions that need to be diligently followed, is the need to use folic acid before pregnancy and during the initial stages of pregnancy, as this will mitigate the possible effects to the fetus.
Other precautions include the possibility of liver complications among individuals on the medication, and this includes the possibility of serious complications. There are clear tell-tale symptoms that can be used to identify if there are any such outcomes. For instance, pain in the stomach or abdomen, discoloration of the stools, discoloration of urine, and reduction in appetite are all indications of possible impact or effect son the liver. Other indicators of undesirable effects on the liver include swelling in the feet, or the lower portion of the legs, and yellowish appearance in the eyes or the skin.
The medication is also known to cause some form of changes in behavior. For instance, the individual on the drug may display some form of abnormal conduct, such as being agitated, or easily irritable, or have suicidal tendencies. Depression is another possible outcome from the medication, and caregivers are expected to be alert to the possibilities and take suitable actions as required.
Effect on alcohol
Valproic acid is known to amplify the effects of intoxicating substances such as alcohol. This may also apply to medications that have a similar effect. Patients and caregivers are to ensure that alcohol is not consumed during the course of treatment and medications that deliver drowsy effects are also not to be combined with valproate.
Fertility of men
In addition to the possible effects on pregnant women, the medication is also likely to have an impact on the fertility of men. While this may not affect all men, it is likely to affect certain men, and it is therefore necessary to discuss the same with a fertility specialist when on the medication.
Avoid driving or operating heavy machinery
As the medication is known to cause drowsiness, users are not to drive, operate heavy machinery or discharge responsibilities that require a high state of alertness. Reflexes of patients are likely to be reduced or compromised to an extent and this makes it necessary to avoid all responsibilities that may impact or jeopardize the life and safety of others.
Discontinuation of medication
The medicine is not to be discontinued abruptly. Ideally, the dosage is to be gradually lowered, before being fully stopped. This is necessary to prevent undesirable outcomes and withdrawal symptoms. This is also necessary to prevent the seizures from aggravating as a result of sudden discontinuation of the anticonvulsant.
Impact on other laboratory tests
The mediation is likely to have an impact on the results of certain laboratory tests. It is therefore necessary to inform the specialists and the laboratory about the use of this medication. This is necessary to either postpone the tests or to interpret the findings of the tests against the backdrop of this information.
Possible valproic acid side effects
All drugs without exception come with the possibility of side effects. The intensity, and duration of effects may differ from person to person, with some experiencing stronger or potent side effects, while some may experience mild or moderate effects. It is also necessary to remember that certain individuals may not experience any kind of effects whatsoever, and this is perfectly normal and is not to be considered as abnormal.
Allergic reactions from valproate
There is the possibility of allergic reactions arising out of use of valproic acid. This is not to be dismissed as trivial or ignored. There is the possibility of the allergic reaction aggravating to serious proportions and it is therefore necessary to prevent it from becoming an adverse reaction. Allergies may affect multiple organs of the body and this may seriously impact health of the patient. For instance, allergies from valproic acid medications may impact the liver and the kidneys and this needs to be prevented or resolved at the earliest. Simple symptoms will help identify allergic reactions. Users are advised to look for symptoms such as discoloration of the urine, feces, abnormal swelling, yellowish tint in the skin, eyes, and fatigue.
Side effects of the medication also include possible pancreatitis. Symptoms that are indicative of this condition include pain in the stomach that could be severe in nature, and is most likely to start suddenly and not gradually. This may or may not be accompanied by chills, bouts of constipation, and feelings of nausea or vomiting. The patient may also end up with a fever and may experience feelings of light-headedness.
The medication is also likely to trigger blood complications and symptoms that are indicative of this condition include fever and a sore throat. The patient may experience the outbreak of rashes, ulcers in the mouth, and possible nosebleeds. In addition to the above, the patient may also experience bleeding in the gums, and possible swelling in glands. The color of the skin may also change with the appearance of small reddish spots on the skin. This could also be purple in color at times.
A rarely occurring side effect that could be experienced by a small section of patients is hyperammonemic encephalopathy. This is a serious condition and needs to be treated at the earliest at a healthcare facility. Patients and caregivers are to carefully monitor and observe if any of the following symptoms are experienced or witnessed. For instance, the patient may experience abnormal drowsiness, or could appear dull and drained of all energy. An overall feeling of weakness may be experienced by the patient who may be slow to react or act. There could a perceptible shift in the mental condition of the patient. Other Discernible effects include sudden reduction in body temperature, and vomiting sensations.
In addition to possible valproic acid side effects mentioned above, there is also the possibility of drug interactions. The outcome of interactions could be either a reduction in efficacy of either of the medications, or it could be an amplified outcome of either of the medications. Additionally, there is also the possibility of the medication triggering stronger undesirable effects of either of the medication.
CNS depressants, such as antihistamines are likely to interact with valproic acid. This includes medication for hay fever, medication for allergies, and OTC products that may be used for managing common cold. In addition to the above, there is also the possibility of the anticonvulsant interacting with tranquilizers, and drugs prescribed for pain relief, especially narco-analgesics. Barbiturates class of medications prescribed for seizures may also interact with the drug. In addition to the above, valproate may trigger interactions with muscle relaxants, and other drugs belonging to the category of anesthetics, and this also includes anesthetics used for dental procedures.