Epilim Syrup

Introduction

Epilim Syrup 200 mg/5 ml (NaVal) is a short-chain fatty acid, which is used as an antiepileptic medication. It is also known by a range of other names including Depakene, Depakote, Epival, Stavzor, and Valpro. Epilim Syrup 200 mg/5 ml is indicated for treating seizures, mania, and migraine headaches. It is also used to treat bipolar disorder and acute mania related to bipolar disorder.

Uses for

Epilim Syrup 200 mg/5 ml (NaVal) is indicated for the treatment of epilepsy and specific neurological diseases, migraine headache, mania, bipolar disorder, agitation, and other psychiatric disorders. It can also be used as an adjunct in the treatment of major depression.

Brand Name	Epilim
Type	Syrup
Weight	200 mg/5 ml
Generic	Sodium Valproate
Manufacturer	Sanofi Bangladesh Ltd.
Available in	English বাংলা

Mechanism of Action

Epilim Syrup 200 mg/5 ml (NaVal) exerts its therapeutic action mainly through the inhibition of several neurotransmitter systems such as glutamate, gamma-aminobutyric acid (GABA), and noradrenaline.

How Long Does it Take to Work?

The onset of action of Epilim Syrup 200 mg/5 ml (NaVal) depends on its route of administration. When administered orally, it takes approximately 6 to 12 hours for the drug to reach its maximal effect. When administered intravenously, it takes approximately 15 to 30 minutes for the maximal therapeutic effect to be achieved.

Absorption

Epilim Syrup 200 mg/5 ml (NaVal) is readily absorbed after oral administration and the serum concentrations reach a peak 1-4 hours after administration. The bioavailability of orally administered Epilim Syrup 200 mg/5 ml (NaVal) ranges from 50-75%.

Route of Elimination

Epilim Syrup 200 mg/5 ml (NaVal) is mainly metabolized in the liver by the enzyme, glucuronosyl transferase. The metabolites are then excreted in the bile and urine.

Dosage

Oral: Sodium Valproate tablets may be given once or twice daily and syrup should be given in divided doses.

Epilepsy:

Adult: Initially, 600 mg daily is given in 2 divided doses, preferably after food, increasing by 200 mg/day at 3-day intervals to a maximum of 2.5 g daily in divided doses until control of seizure is achieved. Usual maintenance dose is 1-2 g daily (20-30 mg/kg daily).
Children (over 20 kg)- Initially 400 mg daily in divided doses increased until control (usually in the range of 20-30 mg/kg daily); Maximum 35 mg/kg daily.
Children (up to 20 kg)- Initially 20 mg/kg daily in divided doses.

Febrile convulsion: 20-30 mg/kg/day in 3 divided doses.

Bipolar disorder: Initially 600 mg daily (20-30 mg/kg/day) in 2-3 divided doses. The maintenance dosage is 1000-2000 mg daily.

Prophylaxis of migraine: 400-600 mg daily, although some may require 1000-1500 mg daily.

Injection:

Adults- May be given a slow intravenous injection over 3-5 minutes, usually 400-800 mg depending on body weight (up to 10 mg/kg) followed by continuous or repeated infusion up to a maximum of 2500 mg/day.
For children- Initial: 20-30 mg/kg/day, Maximum: 40 mg/kg/day. It may be given by direct slow intravenous injection or by infusion using compatible diluents e.g. 0.9% Sodium Chloride injection, 5% Dextrose injection.

Epilim Syrup 200 mg/5 ml (NaVal) can be administered orally in the form of tablets, capsules, syrup or suspension. The typical recommended doses in adults are 500 to 1000 mg twice daily or 1000 to 3000 mg per day. In children, the dosage ranges from 20 to 60 mg/kg per day, divided into 2 or 3 equal doses.

Administration

Epilim Syrup 200 mg/5 ml (NaVal) should be taken orally with meals. The tablet or capsule should not be crushed, chewed or broken before being swallowed to ensure maximum efficacy. It should preferably be taken with milk or food to reduce stomach-related side effects.

Side Effects

Common side effects of Epilim Syrup 200 mg/5 ml (NaVal) include nausea, vomiting, stomach pain, headache, dizziness, anorexia, depression, skin rash, sedation, tremor, weight changes, fatigue, hair loss, abdominal discomfort, and increased appetite.

Toxicity

Ingestion of large amounts of Epilim Syrup 200 mg/5 ml (NaVal) can lead to overdose, which can cause symptoms such as confusion, coma, drowsiness, hypotension, cardiovascular collapse, and death. The therapeutic dose of this drug should not be exceeded.

Precaution

Before taking Epilim Syrup 200 mg/5 ml (NaVal), it is important to inform your physician if you are pregnant or nursing, have any allergies, have any liver or kidney disease, are taking any other medications, or have a history of mental illness. It is also important to keep in mind that this medication may impair your ability to drive or operate heavy machinery.

Interaction

Epilim Syrup 200 mg/5 ml (NaVal) can interact with a number of other medications and certain foods. Combining it with certain drugs can lead to increased side effects and decreased therapeutic effect. It should also not be taken together with alcoholic beverages since this can also increase the risk of side effects.

Disease Interaction

Epilim Syrup 200 mg/5 ml (NaVal) can interact with several medical conditions such as kidney and liver disease, porphyria, and any other condition that affects the metabolism. Therefore, it is important to ensure that your physician is aware of your medical history before taking this medication.

Drug Interaction

Epilim Syrup 200 mg/5 ml (NaVal) may interact with other drugs such as aspirin, anticoagulants, oral contraceptives, barbiturates, salicylates, sulfonamides, theophylline, warfarin, hydantoins, antihistamines, phenobarbital, and some antibiotics. Therefore, it is important to inform your physician if you are taking any other medications.

Food Interactions

Some foods may interact with Epilim Syrup 200 mg/5 ml (NaVal). It is important to avoid alcohol and foods that contain high amounts of fat while taking this medication. It is also important to keep in mind that grapefruit juice may interact with this medication, so it is best to avoid drinking it.

Pregnancy Use

The use of Epilim Syrup 200 mg/5 ml (NaVal) in pregnancy has not been well studied. Therefore, it is recommended to avoid using this medication during pregnancy as it may cause harm to the developing fetus.

Lactation Use

The use of Epilim Syrup 200 mg/5 ml (NaVal) is not suggested in lactating mothers as it passes through breast milk and can cause serious side effects in the infant. Therefore, it is recommended that mothers who are breastfeeding avoid using this medication.

Acute Overdose

In case of acute overdose with Epilim Syrup 200 mg/5 ml (NaVal), seek immediate medical attention as it can be life-threatening. Symptoms of overdose include coma, drowsiness, confusion, hypotension, and cardiovascular collapse.

Contraindication

Epilim Syrup 200 mg/5 ml (NaVal) is contraindicated in patients with known hypersensitivity to any of its components and pregnant women. It is also contraindicated in patients undergoing treatment for Fulminant hepatic failure as it can cause liver damage.

Use Direction

Epilim Syrup 200 mg/5 ml (NaVal) must always be used as per the directions of the healthcare provider. It must not be taken in larger or smaller quantities than what is prescribed by the healthcare provider. The patient must also ensure that the medication is taken at the same time every day to maintain therapeutic concentrations.

Storage Condition

Epilim Syrup 200 mg/5 ml (NaVal) must be stored in a cool, dry place away from moisture and heat. The medication must also be kept out of reach of children and away from direct sunlight.

Volume of Distribution

The volume of distribution of Epilim Syrup 200 mg/5 ml (NaVal) is 0.9-1.2 L/kg. It is primarily distributed to the tissues in the body.

Half life

The half-life of Epilim Syrup 200 mg/5 ml (NaVal) is between 6 and 16 hours. However, its elimination rate is reduced in elderly patients or in patients with hepatic impairment.

Clearance

The clearance of Epilim Syrup 200 mg/5 ml (NaVal) is 1.1-2.6 ml/min/kg. The rate of clearance is reduced in elderly patients or in patients with hepatic impairment.

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