What is Valproate?
Valproate, also known as valproic acid or divalproex sodium, is a medication primarily used to treat
epilepsy and
bipolar disorder. It is also used to prevent
migraine headaches. In pediatrics, its primary use is in the management of seizure disorders. Valproate works by increasing the amount of gamma-aminobutyric acid (GABA) in the brain, which helps to calm the nervous system.
Indications for Use in Pediatrics
In the pediatric population, valproate is indicated for the treatment of various seizure types including
absence seizures,
complex partial seizures, and generalized tonic-clonic seizures. It is also used in the management of
mood disorders in children and adolescents, though this is less common.
How is Valproate Administered?
Valproate can be administered in several forms including oral tablets, capsules, liquid, and an intravenous formulation. The choice of formulation depends on the age of the child, the severity of the condition, and how well the child can swallow pills. Dosing is usually initiated at a low level and gradually increased to minimize side effects and achieve optimal control of symptoms.
Valproate is generally well tolerated in children, but it can cause side effects. Common side effects include
nausea,
vomiting,
drowsiness, and
dizziness. More serious side effects can include liver toxicity, pancreatitis, and
blood disorders. It is important to monitor liver function and blood counts regularly while a child is on valproate.
Special Considerations in Pediatrics
There are several considerations when prescribing valproate to pediatric patients. Children with certain metabolic disorders, such as
urea cycle disorders, are at higher risk for complications and may require alternative treatments. Additionally, valproate is known to cause congenital malformations, so it is contraindicated in pregnant adolescents and those who may become pregnant unless no other treatment options are available.
Monitoring and Follow-Up
Regular monitoring is essential for children taking valproate. This includes checking liver function tests, complete blood counts, and serum valproate levels. It is crucial to ensure that therapeutic levels are achieved without reaching toxic levels. Follow-up visits should also assess the child's seizure frequency, side effects, and overall development and behavior.
Alternatives to Valproate
For children who cannot tolerate valproate or for whom it is contraindicated, several alternative medications are available. These include
lamotrigine,
levetiracetam, and
topiramate. The choice of alternative drug depends on the specific type of seizure disorder and the child's individual response to medication.
Conclusion
Valproate is a valuable medication in the pediatric arsenal for treating seizure disorders and mood dysregulation. Its use requires careful consideration of potential side effects and ongoing monitoring to ensure safety and efficacy. Collaboration between healthcare providers, parents, and patients is essential to optimize treatment outcomes and improve the quality of life for pediatric patients on valproate.
