Nutrition Valproate

Elderly In elderly patients, increase dosage more slowly and with regular monitoring for fluid and nutritional intake, dehydration, somnolence, and other adverse events. Consider dose reductions or discontinuation of valproate in patients with decreased food or fluid intake and in patients with excessive somnolence. A reduced starting dose is recommended (see Administration and Dosage). 

Adverse effects are most commonly manifest as acute pancreatitis. The strongest association is with alcohol abuse. High plasma calcium, including that caused by hypervitaminosis D, and parenteral nutrition also increase the risk. Corticosteroids, didanosine, azathoipurine, diuretics (including thiazides and frusemide), sodium valproate, mesalazine and paracetamol (in overdose) have also been causally related. 

Nishida, N., Sugimoto, T., Araki, A., Woo, M., Sakane, Y. Kobayashi, Y. (1981) Pediatr. Res. 22, 500-503. Carnitine metabolism in valproate-treated rats The effect of L-Camitine supplementation. Nagao, M., Parimoo, B. Tanaka, K. (1993) J. Biol Chem 268, 24114-24124. Developmental, nutritional, and hormonal regulation of tissue-specific expression of the genes encoding various acyl-CoA dehydrogenases and a-subunit of electron transfer flavoprotein in rat. 

Carnitine In 60 children with primary epilepsy free of neurological or nutritional problems who took valproate for at least 1 year, mean total carnitine and free carnitine concentrations were significantly lower compared with pre-treatment and control concentrations, while ammonia, acyl-carnitine, and the acylcamitine/free carnitine ratio were significantly higher [366. Total carnitine and free carnitine were negatively associated with ammonia concentration. These results confirm previous findings of an interaction between the metabolism of valproate and carnitine. 

Nutrition Homocysteine levels were found to be significantly higher in patients taking sodium VPA as compared to controls, while serxim levels of vitamin B12 were significantly lower. The authors suggested that these abnormalities may contribute to atherosclerosis in patients taking sodixim valproate [51 ]. 

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