Valproic acid & Sodium valproate
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Q:  Valproic acid & Sodium valproate

Resp sir,
            i am a patient's friend from india. My friend has been prescribed for acute manic episodes with a combination of 2:1 of Na valp + Valproic acid 200mg b.i.d dosing whereas i came across a medical friend of mine who had suggested to ask the dr to prescribe Divalproex sodium 250mg which as per him is a better version of Valproate than the brand(Epilex Chrono)with a 1:1 molar conc of NaValp + Valproic acid. How do they differ from each other?, for the dr also was confused when this question was put to him. pl help with a differentiation between the 2 molecules.

Dear Sir -- 
Readers with a better organic chemistry background than I may be able to make more of the distinction I'm about to describe, which you've basically already figured out: 

Forms of the active ingredient, the valproate ion (you could think of that as V-)

  • Sodium valproate (V. Na; dissolving into V- and Na when it hits the water of the stomach)
  • Valproic acid (V. H); dissolving into  V- and H+ when it hits the water of the stomach)
  • Combinations of the two
        a) "divalproex sodium" (U.S.: Depakote; Canada: Epival), which is a 1:1 mixture
        b) some 2:1 mixture your friend is taking, which is not available -- to my knowledge -- in the U.S. (Epilex Chrono, if I interpret you correctly)

Now, does it make any difference?  I'm not aware of any literature comparing the two mixtures (1:1 versus 2:1).  There could be such a literature (send me some if you find it).  From what I know so far, always open to learning more, it shouldn't make any difference in the effectiveness of the medications, because all of these forms end up yielding the valproate ion which is the active form of the medication.  The difference is said to be, as I understand it, that the combinations are better in terms of side effects than the Sodium Valproate version (in the U.S., that's Depakene).  The latter causes much more stomach irritation and thus nausea.  

So if your friend is not having stomach problems with the current one, and there's no other reason to look at switching, I don't think there would be any improvement to be had from switching.  Again, I could be wrong, let me know if you learn otherwise.  Thanks.  A basic reference from a solid source on this which I consulted for this reply is .  

Dr. Phelps

Published January, 2003


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