Valproate (valproic acid): uses and side effects of this drug.

A type of psychotropic drug used against epilepsy and the prevention of manic episodes.

Since ancient times, hundreds of disorders and alterations have affected human health. But among all the diseases, there is one linked to the hyperexcitability of neuronal groups that is so ancient and virulent that it was considered "the sacred disease".

This is epilepsya condition that has been little understood until relatively recently and which has major repercussions for the sufferer if left untreated.

Fortunately, the progress of science has allowed the development of different types of treatment, among which we can find the use of drugs. In this sense, one of the most widely used drugs in the treatment of this condition is valproate or valproic acidwhich we are going to talk about in this article.

Valproic acid or valproate: what is it?

Valproic acid is an Anticonvulsant psychotropic drugIt is a type of substance that is useful in combating and preventing the occurrence of seizures and convulsions in general. It is one of the best known and most widely used drugs in the context of epilepsy treatment, together with carbamazepine and topiramate.

Despite being an anticonvulsant, its chemical composition differs in relation to the rest of the representatives of its group.

Valproate is a highly effective and potent drug (prescription only), which also has euthymic or stabilizing effects. is a highly effective and potent drug (prescription-only), which also has euthymizing or mood-stabilizing effects and is considered to be broad-spectrum. and is considered broad-spectrum. It can be found under various names, such as valproate, manganese valproate or sodium valproate, and some of the best known brand names are Depakote or Depakine.

Valproic acid can be administered by two main routes, oral and intravenous.. The former is the most commercially available, in the form of tablets or pills, and is usually used in outpatient treatment. The intravenous version can be found in the form of vials whose contents are injected, and is usually reserved for the hospital setting or for emergency situations.

Mechanism of action

Valproic acid exerts its effects on the body thanks to a mechanism of action based on the agonism of valproic acid. based on the agonism of gamma-aminobutyric acid or GABAi.e. by promoting the production and action of this neurotransmitter in the organism. In addition, it also generates a decrease in glutamate levels and alters the behavior of the sodium, potassium and calcium receptors of our neurons (reducing their conductivity).

Taking into account that glutamate is one of the excitatory neurotransmitters par excellence of our brain and that GABA is the main inhibitory neurotransmitter of the nervous system, the effects of these alterations in the levels of one and the other will generate a reduction of the nervous activity, something fundamental in the treatment of epilepsy (in which there is a hyperactivation of the nervous system). (in which there is a hyperactivation of groups of neurons that have become hypersensitized, so that a minor stimulation can trigger an intense response) and in other disorders in which there is an excess of neuronal activity.

Main indications for this drug

As an antiepileptic or anticonvulsant, the main indication for valproic acid is in people suffering from epilepsy or seizures. people suffering from epilepsy or seizures, both seizures and "absence seizures".both those involving seizures and the so-called "absence seizures". This drug is prescribed for both adults and children suffering from this condition, although it is necessary to be cautious with the doses and to monitor the possible side effects.

In addition, valproate is the only anticonvulsant that has an official indication for bipolar disorder, although other drugs in the same group could also be beneficial. This is due to the aforementioned euptimizing or mood-stabilizing effect.

It does not increase or decrease mood per se, but keeps it within a certain range. In this sense it is effective in the treatment and prophylaxis of manic episodes.whether it is used together with lithium salts or as monotherapy.

These are not the only indications for valproic acid. In addition to the above, it is also indicated for the treatment of migraines in adults, and its possible efficacy is being explored.In addition, its possible efficacy in problems such as HIV dementia or muscular atrophy due to spinal cord damage is being explored.

Side effects and risks

Valproic acid is a valuable drug that can help treat a variety of conditions, but its use can sometimes lead to undesirable and even dangerous side effects.

Among some of the most common side effects are the presence of tremors, nausea or vomiting.

Other side effects may include extrapyramidal (motor) disturbances, drowsiness, involuntary eye movements, confusion, incontinence, hearing problems, transient hair loss, gum hypertrophy, oral inflammation, abdominal pain, diarrhea, weight gain or memory, attention and learning problems, irritability and aggressiveness.

They can also appear parkinsonism (reversible), incoordination or paraesthesias, dysmenorrhea and pain during menstruation and pain during menstruation, infertility (in the case of men), as well as hallucinations.

More relevant and much more dangerous (in fact potentially fatal, which is why the doses and administration of this drug must be very carefully controlled), although less frequent, are problems such as anemia, hypothyroidism, possible thrombocytopenia or decrease in the number of platelets, decrease in blood sodium, hemorrhages and liver damage, pancytopenia or decrease in the main components of the blood, leukopenia or decreased white blood cells, encephalopathy, pancreatitis, osteoporosis, antidiuretic hormone problems and decreased electrolytes, hyperandrogenism, renal failure, vasculitis, bone marrow failure, increased chance of myelodysplastic syndrome, infertility, rhabdomyolysis, nephritis or clotting problems.

Contraindications

Despite its great usefulness in the treatment of the aforementioned conditions, valproic acid is a very potent drug and, as we have seen, can have very dangerous side effects. can have very dangerous side effects.. In this sense, there are groups and sectors of the population for whom the use of valproate is severely contraindicated.

The use of valproate is contraindicated in those who have any type of people who have any type of liver, pancreas or kidney disease, especially in case of liver, pancreas or kidney failure.especially in the case of renal or hepatic insufficiency. It is also relevant not to be taken by people with any type of hematological condition.

It is also contraindicated and not recommended in the case of pregnant womenIt has been shown to increase the risk of malformations in the fetus and alterations such as spina bifida, as well as the existence of a fetal syndrome due to valproate. In this regard, caution should be exercised not only by pregnant women and nursing mothers, but also by women who are planning to become mothers in the near future (an appointment with the physician will be necessary to evaluate therapeutic alternatives to valproate).

It should not be taken by people allergic to valproate or to any of its excipients, nor should it be used in combination with topiramate or MAOIs (since their interaction can be dangerous). They should not be taken with alcohol and caution should be exercised with the use of hormonal contraceptives (as they may cause interaction). If other drugs are taken, a doctor should be consulted about the suitability of treatment with valproic acid.