Valproate Made Simple: A Guide for People Living with Epilepsy

What Is Valproate?

Valproate (sometimes called valproic acid, or in its salt forms “valproate sodium” or “divalproex”) is a medicine used to help control seizures (in epilepsy).

It is also used in some cases for bipolar disorder (especially when a person is having manic symptoms) and to prevent migraine headaches.

It belongs to the group of drugs called anticonvulsants (sometimes “antiepileptic drugs” or “AEDs”).

In short: valproate is a broadly useful brain-acting drug that can reduce the chance of seizures and has some mood-stabilizing and migraine-preventing roles.

How Does Valproate Work?

Nobody fully knows exactly how it works in every situation, but here are the main ideas:

It helps boost inhibitory activity in the brain (i.e. calming overexcited brain cells). One way is by increasing levels of GABA, a chemical that calms neural activity.

It also affects ion channels (especially sodium and calcium channels) which control electrical signals in nerve cells.

More recently, it has been found to influence gene regulation (epigenetics) via histone deacetylases (HDACs) — meaning it can “turn on or off” certain genes more easily.

Because of all these effects acting together, valproate is considered a broad-spectrum anti-seizure drug — useful for many types of seizures. ** What Kinds of Epilepsy / Seizures Can Valproate Treat?**

Valproate is used in many seizure types. Some examples:

Absence seizures (“staring spells”) — simple or complex absence

Tonic-clonic seizures (formerly “grand mal”)

Myoclonic seizures (brief jerks)

Mixed or multiple seizure types (i.e. when someone has more than one kind)

Some forms of severe epilepsy syndromes in children

Because of its broad effect, valproate is often a go-to option when doctors want one drug that works for more than one kind of seizure.

How Is Valproate Taken?

It comes in various forms: capsules, delayed-release tablets, extended-release tablets, syrup (liquid), sprinkle (small beads that can be placed on food), and injection (in hospital settings).

Sometimes people take it two or more times per day; the extended-release forms may be taken just once daily.

It’s usually taken with food (to reduce upset stomach) and at consistent times each day.

Because there are different “forms” (valproic acid, valproate sodium, divalproex), switching between them may require dose adjustment.

Importantly: You should not stop taking valproate suddenly. Doing so might cause more or worse seizures. Any changes should be under medical supervision.

What Are the Common Side Effects?

Like all medications, valproate has side effects. Many are mild, but some can be serious. Below is a list to know — though not everyone will get them.

Common / milder side effects:

Nausea, vomiting, stomach upset

Drowsiness, dizziness, fatigue

Tremor (shaking)

Hair thinning or hair loss (often temporary)

Weight gain

Changes in appetite, digestion, mild liver enzyme elevations

Low platelet counts (platelets are cells in your blood that help with clotting)

Serious / less common risks (you should watch for):

Liver damage / liver failure — the risk is higher in young children (especially under age 2), or in people already having liver problems.

Pancreatitis (inflammation of the pancreas) — this can happen at any time.

Birth defects / developmental problems if used in pregnancy (see below)

Mood changes, depression, suicidal thoughts — as with many anti-seizure drugs, mood effects must be monitored.

Bleeding / clotting issues if platelet counts drop too low

If someone on valproate notices unusual fatigue, yellowing of skin or eyes, stomach or back pain, confusion, or mood shifts, they should contact their doctor right away.

Special Caution: Pregnancy and Childbearing

One of the biggest concerns with valproate is the risk to a developing fetus if a woman takes it during pregnancy. Here’s what to know:

Valproate is strongly associated with birth defects — including defects of the spine (neural tube), heart abnormalities, and limb problems.

Babies exposed to valproate in the womb may also be at risk for developmental delays, lower IQ, autism, and learning or behavioral issues.

Because of these risks, valproate is generally avoided in women of childbearing potential unless no safer alternative works.

Women on valproate who are capable of becoming pregnant should use effective birth control and should discuss the risks and benefits with their neurologist and obstetrician.

If pregnancy is planned (or detected), a full discussion of alternatives, dose adjustments, and fetal monitoring is required.

Stopping or changing seizure medicines during pregnancy can be risky for both mother and baby — sudden changes may provoke seizures, which themselves carry risks. Thus, decisions must be individualized and closely supervised.

Because of this, many epilepsy treatment guidelines now recommend that valproate not be first choice in women of childbearing age — unless absolutely needed and when precautions are in place.

Who Should Not Use Valproate?

Valproate is not safe or recommended in certain situations:

People with serious liver disease or in whom liver function is already impaired.

Children under 2 years old, especially when combined with other seizure drugs, unless the benefits clearly justify the risk.

People with mitochondrial disease or a genetic disorder affecting metabolism of drugs (e.g. Alpers’ syndrome)

Women who are pregnant or planning pregnancy, unless risks are carefully managed and no better alternative exists. (As discussed above)

People with certain blood disorders, or those prone to bleeding if platelet counts might fall further

Also, doctors must watch for drug interactions (i.e. when valproate changes how other drugs work or vice versa). Regular lab tests are often required.

Monitoring and Safety When Taking Valproate

If someone is prescribed valproate, these are common precautions and monitoring steps:

Blood tests: to check liver function, kidney function, blood count (especially platelets)

Drug level checks (“trough levels” in blood) to make sure the amount of drug is in a safe and effective range

Monitoring for side effects (monitoring mood, weight, signs of liver/pancreas trouble)

For women of childbearing age: frequent counseling on birth control, pregnancy planning, and fetal risk

Regular checkups and being cautious when other medications are added or changed

Pros and Cons in Simple Summary

Pros / strengths

Works for many seizure types (broad coverage)

Sometimes the only drug that can control difficult-to-manage seizures

Long clinical experience (doctors have many years of data on how people respond)

Cons / risks

Serious risks to the liver, pancreas, blood counts

High risk of birth defects and developmental problems if used in pregnancy

Side effects like weight gain, hair loss, tremor, drowsiness

Needs careful monitoring, dose adjustments, and awareness of interactions

So, valproate can be a powerful tool — but one that requires respect, caution, and individualized decision-making.

Tips / Advice for Patients & Caregivers

Always take the medicine exactly as prescribed (same dose, times, with or without food as advised).

Never stop it abruptly without your doctor’s guidance.

Keep a log of any side effects, changes in mood, or any unusual symptoms.

Make sure your doctor knows your full medical history and all other medications (including over-the-counter, herbal supplements).

If you are a woman who can become pregnant, discuss contraception, pregnancy risks, and alternative treatments with your doctor.

Go for regular lab checks as recommended.

If you notice signs like yellowing skin/eyes, stomach pains, severe nausea, mood changes, bleeding, or extreme drowsiness — don’t wait. Contact your doctor immediately.

References / Sources

MedlinePlus – Valproic Acid (Drug Information) https://medlineplus.gov/druginfo/meds/a682412.html

NCBI / StatPearls — Valproic Acid https://www.ncbi.nlm.nih.gov/books/NBK559112/

DrugBank — Valproic Acid https://go.drugbank.com/drugs/DB00313

“Valproic Acid and Epilepsy: From Molecular Mechanisms to Clinical Use” (PMC article) https://pmc.ncbi.nlm.nih.gov/articles/PMC7052829/

NHS (UK) — Valproic Acid: medicine used for epilepsy, bipolar disorder, migraine https://www.nhs.uk/medicines/valproic-acid/

WebMD — Valproic Acid (Depakene, Stavzor) — Uses, Side Effects, & Warnings https://www.webmd.com/drugs/2/drug-8885/valproic-acid-oral/details

Drugs.com — Valproic Acid https://www.drugs.com/mtm/valproic-acid.html

Epilepsy Ontario — Valproic Acid https://epilepsyontario.org/about-epilepsy/treatments/medications/valproic-acid/