Valproinsyra
Valproinsyra
Klass: 2
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Absenor, Absenor Depot, Convulex, Delepsine, Depakine, ......
Absenor, Absenor Depot, Convulex, Delepsine, Depakine, Depakine Retard, Deprakine, Ergenyl, Ergenyl Retard, Ergenyl intravenös, Orfiril, Orfiril long, Valproinsyra EbbATC-Koder
N03AG01
N03AG01Substanser
natriumvalproat, valproinsyra
natriumvalproat, valproinsyraRekommendation för hälso- och sjukvården
Risken för ett friskt fullgånget barn bedöms vara måttlig vid terapeutiska doser. Barnet bör dock observeras med avseende på biverkningar (t ex slöhet och dålig viktuppgång) och koncentrationsbestämning hos barnet kan vara till hjälp.
Risken för ett friskt fullgånget barn bedöms vara måttlig vid terapeutiska doser. Barnet bör dock observeras med avseende på biverkningar (t ex slöhet och dålig viktuppgång) och koncentrationsbestämning hos barnet kan vara till hjälp.Råd till allmänheten
Kontakta läkare för diskussion innan behandling påbörjas.
Kontakta läkare för diskussion innan behandling påbörjas.Bakgrund
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Passerar över till bröstmjölk i hög grad. Baserat på data från närmare 110 kvinnor kan den relativa barndosen beräknas till max 14 % (1-8, 20). Koncentrationer upp till 121 µmol/L har uppmätts hos 14 barn (terapeutiskt intervall 350-700 µmol/L) (2-3,9-12,20). Inga negativa effekter har rapporterats hos ca 30 ammade barn (3-6,9-10,12-15). Barn som exponerats in utero för valproat och hade ammats (n=11) hade möjligen något högre IQ respektive mindre försenad utveckling än barn som exponerats men inte am......
Passerar över till bröstmjölk i hög grad. Baserat på data från närmare 110 kvinnor kan den relativa barndosen beräknas till max 14 % (1-8, 20). Koncentrationer upp till 121 µmol/L har uppmätts hos 14 barn (terapeutiskt intervall 350-700 µmol/L) (2-3,9-12,20). Inga negativa effekter har rapporterats hos ca 30 ammade barn (3-6,9-10,12-15). Barn som exponerats in utero för valproat och hade ammats (n=11) hade möjligen något högre IQ respektive mindre försenad utveckling än barn som exponerats men inte ammats (16-19). Anemi, trombocytopeni, alopeci och slöhet har rapporterats hos tre ammade barn (1,11, 21). De flesta av barnen hade dock även exponerats in utero och i flera fall för andra antiepileptika.Referenser
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Espir MLE, Benton P, Will E, Hayes MJ, Walker G. Sodium valproate (Epilim) -- some clinical and pharmacological aspects. Clinical and pharmacological aspects of sodium valproate in the treatment of epilepsy: proceedings of a symposium. Legg,N.J.; 1976. 145-151.
Bardy AH, Granstrom ML, Hiilesmaa VK. Valproic acid and breast-feeding. In: Janz D, Bossi L, Dam M, editors. Epilepsy, pregnancy and the child. New York: Raven Press; 1982. 359-360.
Alexander FW. Sodium valproate and pregnancy. Arch Dis Child 1979;54(3):240
Nau H, Rating D, Koch S, Hauser I, Helge H. Valproic acid and its metabolites: placental transfer, neonatal pharmacokinetics, transfer via mothers milk and clinical status in neonates of epileptic mothers. J Pharmacol Exp Ther 1981;219(3):768-777
von Unruh GE, Froescher W, Hoffmann F, Niesen M. Valproic acid in breast milk: how much is really there? Ther Drug Monit 1984;6(3):272-276
Tsuru N, Maeda T, Tsuruoka M. Three cases of delivery under sodium valproate--placental transfer, milk transfer and probable teratogenicity of sodium valproate. Jpn J Psychiatry Neurol 1988;42(1):89-96
Meyer FP, Quednow B, Potrafki A, Walther H. [Pharmacokinetics of anticonvulsants in the perinatal period]. Zentralbl Gynakol 1988;110(19):1195-1205
Dickinson RG, Harland RC, Lynn RK, Smith WB, Gerber N. Transmission of valproic acid (Depakene) across the placenta: half-life of the drug in mother and baby. J Pediatr 1979;94(5):832-5.
Piontek CM, Baab S, Peindl KS, Wisner KL. Serum valproate levels in 6 breastfeeding mother-infant pairs. J Clin Psychiatry 2000;61(3):170-172
Birnbaum CS, Cohen LS, Bailey JW, Grush LR, Robertson LM, Stowe ZN. Serum concentrations of antidepressants and benzodiazepines in nursing infants: A case series. Pediatrics 1999;104(1):e11
Stahl MM, Neiderud J, Vinge E. Thrombocytopenic purpura and anemia in a breast-fed infant whose mother was treated with valproic acid. J Pediatr 1997;130(6):1001-1003
Wisner KL, Perel JM. Serum levels of valproate and carbamazepine in breastfeeding mother-infant pairs. J Clin Psychopharmacol 1998;18(2):167-169
Johannessen SI, Helde G, Brodtkorb E. Levetiracetam concentrations in serum and in breast milk at birth and during lactation. Epilepsia 2005;46(5):775-777
Aydin B, Nayir T, Sahin S, Yildiz A. Olanzapine and quetiapine use during breastfeeding: excretion into breast milk and safe breastfeeding strategy. J Clin Psychopharmacol. 2015;35:206-8.
Philbert A, Pedersen B, Dam M. Concentration of valproate during pregnancy, in the newborn and in breast milk. Acta Neurol Scand 1985;72(5):460-463
Meador KJ, Baker GA, Browning N, Cohen MJ, Bromley RL, Clayton-Smith J et al. Breastfeeding in children of women taking antiepileptic drugs: cognitive outcomes at age 6 years. JAMA Pediatr. 2014;168:729-36.
Meador KJ, Baker GA, Browning N, Clayton-Smith J, Combs-Cantrell DT, Cohen M et al. Effects of breastfeeding in children of women taking antiepileptic drugs. Neurology. 2010;75:1954-60.
Veiby G, Engelsen BA, Gilhus NE. Early child development and exposure to antiepileptic drugs prenatally and through breastfeeding: a prospective cohort study on children of women with epilepsy. JAMA Neurol. 2013;70:1367-74.
Vajda F. Epilepsy: Effects of exposure to antiepileptic drugs during development. Nat Rev Neurol. 2014;10:11-2.
Kacirova I, Grundmann M, Brozmanova H. Valproic acid concentrations in nursing mothers, mature milk, and breastfed infants in monotherapy and combination therapy. Epilepsy Behav. 2019;95:112-116.
Govindan K, Mandadi GD. Alopecia in Breastfed Infant Possibly Due to Mother Getting Valproate. Indian J Pediatr. 2021;88(5):519-520.
- Espir MLE, Benton P, Will E, Hayes MJ, Walker G. Sodium valproate (Epilim) -- some clinical and pharmacological aspects. Clinical and pharmacological aspects of sodium valproate in the treatment of epilepsy: proceedings of a symposium. Legg,N.J.; 1976. 145-151.
- Bardy AH, Granstrom ML, Hiilesmaa VK. Valproic acid and breast-feeding. In: Janz D, Bossi L, Dam M, editors. Epilepsy, pregnancy and the child. New York: Raven Press; 1982. 359-360.
- Alexander FW. Sodium valproate and pregnancy. Arch Dis Child 1979;54(3):240
- Nau H, Rating D, Koch S, Hauser I, Helge H. Valproic acid and its metabolites: placental transfer, neonatal pharmacokinetics, transfer via mothers milk and clinical status in neonates of epileptic mothers. J Pharmacol Exp Ther 1981;219(3):768-777
- von Unruh GE, Froescher W, Hoffmann F, Niesen M. Valproic acid in breast milk: how much is really there? Ther Drug Monit 1984;6(3):272-276
- Tsuru N, Maeda T, Tsuruoka M. Three cases of delivery under sodium valproate--placental transfer, milk transfer and probable teratogenicity of sodium valproate. Jpn J Psychiatry Neurol 1988;42(1):89-96
- Meyer FP, Quednow B, Potrafki A, Walther H. [Pharmacokinetics of anticonvulsants in the perinatal period]. Zentralbl Gynakol 1988;110(19):1195-1205
- Dickinson RG, Harland RC, Lynn RK, Smith WB, Gerber N. Transmission of valproic acid (Depakene) across the placenta: half-life of the drug in mother and baby. J Pediatr 1979;94(5):832-5.
- Piontek CM, Baab S, Peindl KS, Wisner KL. Serum valproate levels in 6 breastfeeding mother-infant pairs. J Clin Psychiatry 2000;61(3):170-172
- Birnbaum CS, Cohen LS, Bailey JW, Grush LR, Robertson LM, Stowe ZN. Serum concentrations of antidepressants and benzodiazepines in nursing infants: A case series. Pediatrics 1999;104(1):e11
- Stahl MM, Neiderud J, Vinge E. Thrombocytopenic purpura and anemia in a breast-fed infant whose mother was treated with valproic acid. J Pediatr 1997;130(6):1001-1003
- Wisner KL, Perel JM. Serum levels of valproate and carbamazepine in breastfeeding mother-infant pairs. J Clin Psychopharmacol 1998;18(2):167-169
- Johannessen SI, Helde G, Brodtkorb E. Levetiracetam concentrations in serum and in breast milk at birth and during lactation. Epilepsia 2005;46(5):775-777
- Aydin B, Nayir T, Sahin S, Yildiz A. Olanzapine and quetiapine use during breastfeeding: excretion into breast milk and safe breastfeeding strategy. J Clin Psychopharmacol. 2015;35:206-8.
- Philbert A, Pedersen B, Dam M. Concentration of valproate during pregnancy, in the newborn and in breast milk. Acta Neurol Scand 1985;72(5):460-463
- Meador KJ, Baker GA, Browning N, Cohen MJ, Bromley RL, Clayton-Smith J et al. Breastfeeding in children of women taking antiepileptic drugs: cognitive outcomes at age 6 years. JAMA Pediatr. 2014;168:729-36.
- Meador KJ, Baker GA, Browning N, Clayton-Smith J, Combs-Cantrell DT, Cohen M et al. Effects of breastfeeding in children of women taking antiepileptic drugs. Neurology. 2010;75:1954-60.
- Veiby G, Engelsen BA, Gilhus NE. Early child development and exposure to antiepileptic drugs prenatally and through breastfeeding: a prospective cohort study on children of women with epilepsy. JAMA Neurol. 2013;70:1367-74.
- Vajda F. Epilepsy: Effects of exposure to antiepileptic drugs during development. Nat Rev Neurol. 2014;10:11-2.
- Kacirova I, Grundmann M, Brozmanova H. Valproic acid concentrations in nursing mothers, mature milk, and breastfed infants in monotherapy and combination therapy. Epilepsy Behav. 2019;95:112-116.
- Govindan K, Mandadi GD. Alopecia in Breastfed Infant Possibly Due to Mother Getting Valproate. Indian J Pediatr. 2021;88(5):519-520.
Författare
Klinisk farmakologi, Karolinska Universitetssjukhuset för Hälso- och sjukvårdsförvaltningen, Region Stockholm. Janusmed amning uppdateras kvartalsvis.
Klinisk farmakologi, Karolinska Universitetssjukhuset för Hälso- och sjukvårdsförvaltningen, Region Stockholm. Janusmed amning uppdateras kvartalsvis.Fasstexter
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Innehållet senast uppdaterat 5/17/2022