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Anticonvulsant medications - valproic acid derivatives

• Medications
• Depletions
• Editorial Note
• Supporting Research

Medications

• Valproic Acid and Derivatives
  • Depacon™
  • Depakene®
  • Depakote® Delayed Release
  • Depakote® ER

Depletions

Carnitine (L-Carnitine)

Although carnitine is made by the body, deficiency can occur and may be associated with anemia, fatigue, increased blood levels of ammonia, lethargy, unexplained stupor, and heart irregularities.

Copper

Although copper deficiency is rare, signs and symptoms of long-term depletion of copper include anemia, changes in the structure and appearance of hair, heart damage, growth retardation, impaired bone formation, osteoporosis (bone loss), and emphysema (lung disease).

Selenium

Selenium deficiency may be associated with muscular, digestive, and heart disorders; long-term deficiency may be associated with increased risk of developing certain chronic illnesses such as cancer, diabetes, or liver disease.

Vitamin B9 (Folic Acid)

Low levels of folic acid have been linked to anemia, heart disease, and birth defects.

Zinc

Signs and symptoms of zinc deficiency include loss of appetite or sense of taste, growth retardation, skin changes, and increased susceptibility to infection.

Editorial Note

The selected depletions information presented here identifies some of the nutrients that may be depleted by certain medications. The signs and symptoms associated with nutrient deficiency may also indicate conditions other than nutrient deficiency. If you are experiencing any of the signs or symptoms mentioned, it does not necessarily mean that you are nutrient deficient. Nutrient depletion depends upon a number of factors, including your medical history, diet, and lifestyle as well as the length of time you have been taking the medication. Please consult your healthcare provider; he or she can best assess and address your individual healthcare needs, and determine if you are at risk for nutrient depletions from these medications as well as others not listed here.

Supporting Research

Ames BN. Micronutrient deficiencies: A major cause of DNA damage. Ann NY Acad Sci . 2000;889:87-106.

Castro-Gago, M, Eiris-Punal J, Novo-Rodriguez MI, et al. Serum carnitine levels in epileptic children before and during treatment with valproic acid, carbamazepine, and phenobarbital. J Child Neurol . 1998;13(11):546-549.

Chung S, Choi J, Hyun T, Rha Y, Bae C. Alterations in the carnitine metabolism in epileptic children treated with valproic acid. JKMS . 1997;12:553-558.

Coulter DL. Carnitine, valproate, toxicity. J Child Neurol . 1991;61(1):7-14.

Covington T, ed. Nonprescription Drug Therapy Guiding Patient Self-Care . St Louis, MO: Facts and Comparisons; 1999:467-545.

Falchuk KH. Disturbances in Trace Elements. In: Fauci A, Braunwald E, Isselbacher KJ, et al, eds. Harrison's Principles of Internal Medicine . 14 ^th ed. New York, NY: McGraw-Hill Companies Health Professional Division; 1998:490-491.

Goggin T, Gough H, Bissessar A, et al. A comparative study of the relative effects of anticonvulsant drugs and dietary folate on the red cell folate status of patients with epilepsy. Q J Med . 1987;65(247):911-919.

Graf WD, Oleinik OE, Glauser TA, et al. Altered antioxidant enzyme activities in children with a serious adverse experience related to valproic acid therapy. Neuropediatr . 1998;29(4):195-201.

Hambidge M. Human zinc deficiency. J Nutr . 2000;130(5S Suppl):1344S-1349S.

Hurd RW, Rinsvelt HA, Wilder RJ, et al. Selenium, zinc, and copper changes with valproic acid: possible relation to drug side effects. Neurol . 1984;34(10):1393-1395.

Kaji M, Ito M, Okuno T, et al. Serum copper and zinc levels in epileptic children with valproate treatment. Epilepsia . 1992;33(3):555-557.

Lerman-Sagie T, Statter M, Szabo G, et al. Effect of valproic acid therapy on zinc metabolism in children with primary epilepsy. Clin Neuropharmacol . 1987;10(1):80-86.

National Research Council. Recommended Dietary Allowances . 10 ^th ed. Washington, DC: National Academy Press; 1989.

Navarro-Alarcon M, Lopez-Martinez MC. Essentiality of selenium in the human body: relationship with different diseases. Sci Total Environ . 2000;249:347-371.

Sozuer DT, Baruteu UB, Karakoe Y, et al. The effects of antiepileptic drugs on serum zinc and copper levels in children. J Basic Clin Physiol Pharmacol . 1995;6(3-4):265-269.

Van Wouwe JP. Carnitine deficiency during valproic acid treatment. Int J Vitam Nutr Res . 1995;65(3):211-214.

• Review Date: 10/1/2000
• Reviewed By: All depletions monographs have been reviewed by a team of experts including Derrick M. DeSilva, Jr., MD, Raritan Bay Medical Center, Perth Amboy, NJ; Jacqueline A. Hart, MD, Department of Internal Medicine, Newton-Wellesley Hospital, Harvard University and Senior Medical Editor, A.D.A.M., Inc., Boston, MA; John Hinze, PharmD, NMD, Woodbine, IA; Ruth Marlin, MD, Medical Director and Director of Medical Education, Preventive Medicine Research Institute, Sausalito, CA; Brian T Sanderoff, PD, BS in Pharmacy, Clinical Assistant Professor, University of Maryland School of Pharmacy; President, Your Prescription for Health, Owings Mills, MD; Leonard Wisneski, MD, FACP, George Washington University, Rockville, MD; Ira Zunin, MD, MPH, MBA, President and Chairman, Hawaii State Consortium for Integrative Medicine, Honolulu, HI.

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