Also known as: Depacon®, Depakene®, Depakote®, Free Valproic Acid, Stavzor™, Valproate.

Valproate (valproic acid; divalproex sodium, a compound containing sodium valproate and valproic acid) controls myoclonic, absence, and tonic-clonic seizures in idiopathic, generalized, and symptomatic epilepsy. It is the most useful in typical absence seizures. Valproate is as effective as ethosuximide in patients with absence seizures alone and variably effective in atypical absence seizures. Some clinicians prefer valproate for absence seizures, though the American Academy of Pediatrics (Committee on Drugs, 1982) recommended that it be reserved for use when therapeutic failure or intolerance to ethosuximide occurs, because valproate causes rare but potentially fatal hepatotoxicity. Many neurologists consider valproate the drug of choice for those with both absence and other generalized seizure types, including tonic-clonic convulsions. Its efficacy is about the same as in those with the latter type alone. Valproate is an alternative drug in the treatment of complex partial seizures but may be considered for initial therapy in those with partial and secondarily generalized seizures. Valproate is the most popular drug in the treatment of myoclonic epilepsy, with or without generalized tonic-clonic seizures, including juvenile myoclonic epilepsy of Janz, that begins in adolescence or early adulthood. Photosensitive myoclonus is normally easily controlled. Valproate is also effective in the treatment of benign myoclonic epilepsy, postanoxic myoclonus, and, with clonazepam, in severe progressive myoclonic epilepsy, characterized by tonic-clonic seizures as well. It may be preferred in certain stimulus-sensitive (reflex, startle) epilepsies as well.
Valproate may be effective for infantile spasms, but it is relatively contraindicated in children whose spasms are due to hyperglycinemia or other underlying metabolic (mitochondrial) abnormalities. Generally, atonic and akinetic seizures in patients with Lennox-Gastaut syndrome are difficult to control, but valproate is the drug of choice for treatment of mixed seizure types. Because this drug has been useful in some patients who are refractory to all other antiepileptic drugs, it may warrant a trial in nearly all nonresponsive patients regardless of seizure type.