Valproic acid = VPA = Sodium valproate injectable
Valproic acid guidance for second-line treatment of convulsive status epilepticus with strict pregnancy restrictions.
Therapeutic action
Antiseizure (anticonvulsant).
Indications
Second-line treatment of convulsive status epilepticus.
Forms and strengths, route of administration
VPA must not be used in pregnancy or in women and girls of childbearing age. The risk of foetal harm is higher than with other antiseizure medications.
During and after administration, have ventilation equipment and solutions for fluid replacement ready for use.
- 400 mg in 4 ml ampoule (100 mg/ml) for slow IV injection or IV infusion in 0.9% sodium chloride or 5% glucose.
- Do not administer by IM injection.
Dose and duration
In children and adults, do not exceed an infusion rate of 6 mg/kg/minute.
Loading dose
- Child 2 years and over: add 4 ml (400 mg) of VPA to 6 ml of 0.9% sodium chloride to obtain 10 ml of solution containing 40 mg/ml. Administer 20 mg/kg, maximum 1.5 g, over 5 minutes by IV infusion using a syringe pump or by slow IV injection.
- If seizures do not stop after the first dose in children, readminister the same dose: 20 mg/kg, maximum 1.5 g. Do not exceed the total dose of 40 mg/kg or 3 g.
- Adult: 40 mg/kg, maximum 3 g, single dose over 10 minutes.
- Use diluted solution as above if administered by syringe pump. Use undiluted solution if administered by IV infusion in a bag of 100 ml of 0.9% sodium chloride.
- If maintenance treatment is indicated after the loading dose, change to oral route as soon as possible.
Contra-indications, adverse effects, precautions
- Do not administer to women and girls of childbearing age, to children under 2 years, or to patients with pancreatitis, hepatic disease, or history of hepatic disease.
- Reduce dosage in patients with renal impairment.
- May cause drowsiness, extrapyramidal symptoms, behavioural disturbances, confusional state, menstrual irregularities, gastrointestinal disturbances, thrombocytopenia, and rarely pancreatitis, hepatic disorders, prolonged bleeding time, hypersensitivity reactions, hyperammonaemic encephalopathy, respiratory depression, and coma in overdose.
- Stop treatment in the event of pancreatitis, hepatic disorders, severe hypersensitivity, or hyperammonaemic encephalopathy.
- Avoid or monitor combination with mefloquine, carbapenems, tricyclic antidepressants, rifampicin, protease inhibitors, other antiseizure medications, acetylsalicylic acid, erythromycin, isoniazid, benzodiazepines, opioid analgesics, antipsychotics, first-generation antihistamines, and antidepressants.
- Pregnancy: do not use except if vital and no alternative is available. Use a safer drug if possible, such as levetiracetam.
- Breast-feeding: administer with caution and monitor the child.
- Do not mix with other drugs in the same syringe or infusion.
Source
MSF Essential drugs practical guidelines (January 2026)
This page reproduces the structured reference information for this batch while leaving out the Storage and Remarks sections.
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