Parenteral Manual

Valproic acid (SPECIAL ACCESS PROGRAM)

Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
EPIJECT®
Classification: 
Anticonvulsant
Original Date: 
August 2005
Revised Date: 
February 2020
Indications: 
  • IV alternative in patients already stabilized on oral valproic acid when the oral route is temporarily not feasible
  • Acute migraine treatment
Reconstitution and Stability: 
  • 100 mg/mL solution                                                 
  • Store at room temperature
  • Diluted solutions stable for 24 hours at room temperature in D5W, NS and ringer's lactate when stored in glass or PVC bags
Compatibility: 

- Solutions Compatible: D5W, NS, ringer's lactate

Administration: 

(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

SC NO
IM NO
IV Direct NO
IV Intermittent Infusion

YES
Usual dilution: 20 mg/mL
Infusion time: 10 - 60 minutes
Infusion rate: do not exceed 20 mg/minute

                     For migraine therapy can infuse doses up to 1 g over 10 minutes
IV Continuous Infusion NO
Dosage: 

(For neonatal dosages, refer to Neonatal IV Drug Manual.)

Pediatric and Adult: 

Anticonvulsant   

  • Initial: 10-15 mg/kg/day IV divided Q6H.  Increase by 5-10 mg/kg/week until desired response/therapeutic levels achieved.
  • Maintenance: 30-60 mg/kg/day (maximum: 60 mg/kg/day) divided Q6H

If converting from oral to IV dosing, total IV daily dose should be equivalent to total oral daily dose of valproic acid or divalproex  and divided Q6H If IV form administered 2-3 times/day, trough levels can fall below those achieved by the equivalent oral doses

Migraine

  • 20 mg/kg/dose, MAX 1000 mg IV
Potential hazards of parenteral administration: 
  • Nausea, vomiting, abdominal pain, diarrhea
  • Dizziness, headache, somnolence
  • Chest pain
  • Pain at injection site; injection site reaction
  • Taste perversion
  • Other potential adverse effects similar to oral route
Notes: 
  • Monitor liver enzymes, bilirubin, CBC; monitor valproic acid levels when switching from oral to IV or IV to oral therapy; optimal trough level: 350-700 micromol/L
  • Contraindicated in patients with hepatic disease or significant hepatic dysfunction
  • Safety of IV form not well established in children <2 years of age
  • Convert back to oral form as soon as clinically possible
  • Not recommended in acute head trauma or  prophylaxis of post-traumatic seizures
  • Use of IV valproic acid for >14 days has not been studied

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