Anticonvulsant medications - valproic acid derivatives


Valproic acid anticonvulsant medication includes:

Valproic Acid and Derivatives (Depacon, Depakene, Depakote Delayed Release, and Depakote ER)



Osteoporosis (bone loss) is the main disease caused by insufficient calcium. Lack of calcium also may be linked with bone pain and spinal problems. Low levels can also cause:

  • Muscle cramps
  • Irregular heartbeat
  • Depression

Carnitine (L-Carnitine)

Healthy people usually get enough carnitine because the body makes all it needs. But sometimes you can have low levels of carnitine. Being deficient in carnitine can cause:

  • Muscle aches
  • Fatigue
  • Confusion
  • Heart problems


It is rare to have low levels of copper. Over time, low levels of copper can lead to:

  • Anemia
  • Changes in the structure and appearance of hair
  • Heart damage
  • Slow growth
  • Problems with bone formation
  • Osteoporosis (bone loss)
  • Emphysema (lung disease)

Vitamin B3 (Niacin)

Niacin plays a key role in the body's metabolism. Low levels can lead to problems with the skin, digestive system, and nervous system. Symptoms include:

  • Fatigue
  • Stomach problems
  • Depression
  • Vomiting

Severe deficiency can cause pellagra, a disease that can be life threatening if not treated. Symptoms of pellagra include:

  • Inflammation of the skin
  • Depression
  • Abdominal pain
  • Diarrhea


Not getting enough selenium over a period of time may make you more susceptible to developing other conditions, such as cancer, diabetes, or liver disease. Low levels of selenium may be linked to problems with your:

  • Muscles
  • Heart
  • Digestive system

Vitamin B9 (Folic Acid)

Low levels of folic acid have been linked to:

  • Anemia
  • Heart disease
  • Birth defects
  • Colon cancer

Symptoms may include fatigue, mouth sores, swollen tongue, depression, and poor growth.

Vitamin D

Vitamin D works with calcium to keep bones strong. Low levels of vitamin D can cause rickets in children and osteomalacia in adults, conditions where the bones get soft and thin. It can also raise the risk of osteoporosis. More recently, studies have linked low levels of vitamin D with:

  • Weakened immune function
  • Sleep problems
  • Allergies
  • Obesity


Signs and symptoms of low levels of zinc include:

  • Loss of appetite or sense of taste
  • Weakened immune system
  • Slow growth
  • Skin changes
  • Being more susceptible to infection

Editorial Note

The information presented here covers some of the nutrients that may be affected when you take certain medications. If you have the signs and symptoms listed, it does not always mean you have low levels of these nutrients. Many things affect the level of nutrients, including your:

  • Medical history
  • Diet
  • Lifestyle

As well as how long you have been taking the medication. Talk with your health care provider. They can best address your health care needs to determine whether you are at risk for low levels of any nutrients.

Supporting Research

Alexander J. Selenium. Novartis Found Symp. 2007;282:143-9; discussion 149-53, 212-8.

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

Araya M, Pizarro F, Olivares M, Arredondo M, González M, Méndez M. Understanding copper homeostasis in humans and copper effects on health. Biol Res. 2006;39(1):183-7.

Felipez L, Sentongo T. Drug-Induced Nutrient Deficiencies. Pediatric Clinics of North America. 2009; 56(5).

Hoffmann PR. Mechanisms by which selenium influences immune responses. Arch Immunol TherExp (Warsz). 2007; [Epub ahead of print].

Lyon VB, Fairley JA. Anticonvulsant-induced pellagra. J Am Acad Dermatol. 2002;46:597-9.

Maret W, Sandstead HH. Zinc requirements and the risks and benefits of zinc supplementation. J Trace Elem Med Biol. 2006;20(1):3-18.

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

Pelton R, LaValle J, Hawkins EB, et al. Drug Induced Nutrient Depletion Handbook. Hudson, OH: LexiComp, Inc. 2001:405-408.

Powell SR. The antioxidant properties of zinc. J Nutr. 2000;130(5S Suppl):1447S-54S.

Russell S. Carnitine as an antidote for acute valproate toxicity in children. Curr Opin Pediatr. 2007;19(2):206-10.

Shorr: Drugs for the Geriatric Patient, 1st ed. Philadelphia, PA: Elsevier Saunders; 2007.

Tsai MF, Chen CY. Valproate-induced hyperammonemic encephalopathy treated by hemodialysis. Ren Fail. 2008; 30(8):822-4.

Tubek S, Grzanka P, Tubek I. Role of Zinc in Hemostasis: A Review. Biol Trace Elem Res. 2007; [Epub ahead of print].

Yilmaz Y, Tasdemir HA, Paksu MS. The influence of valproic acid treatment on hair and serum zin levels and serum biotinidase activity. Eur J Paediatr Neurol. 2009;13(5):439-43.

Version Info

  • Last reviewed on 8/27/2014
  • Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed HealthCare Network. Also reviewed by the A.D.A.M. Editorial team.

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