Prior to treatment and during the first 6 months of therapy, periodic monitoring of liver function is necessary, especially in patients at risk.
Among the classic tests, the tests reflecting protein synthesis in the liver and especially the prothrombin index are most important. With a significant decrease in the concentration of prothrombin, a pronounced decrease in fibrinogen content, clotting factors, increased bilirubin concentration and transaminase activity, treatment with Valparin® should be stopped.If the patient receives salicylates concomitantly, they should also be immediately withdrawn, since salicylates and valproic acid have common metabolic pathways.
The risk of developing side effects from the liver is increased when combined anticonvulsant therapy, as well as in children.
Early diagnosis is based primarily on clinical examination. In particular, two factors that may precede jaundice should be taken into account, especially in patients at risk:
- nonspecific general symptoms, usually appearing suddenly, such as asthenia, anorexia, extreme fatigue, drowsiness, sometimes accompanied by repeated vomiting and abdominal pain;
- relapse of epileptic seizures against the background of antiepileptic therapy.
It is necessary to warn the patient, and if it is a child, then his family, the need to immediately notify the doctor about the occurrence of these symptoms. In addition to clinical examination in such cases, an analysis of liver function should be performed immediately.
In rare cases, severe forms of pancreatitis, sometimes with a fatal outcome.These cases were observed regardless of the patient's age and duration of treatment, although the risk of developing pancreatitis decreased with increasing age of the patients. Lack of liver function in pancreatitis increases the risk of death.
It should be emphasized that in the treatment of both Valparin® and other antiepileptic drugs, there may be a small, isolated and temporary increase in hepatic transaminase activity, especially at the beginning of treatment, in the absence of any clinical symptoms. In this case, a more complete examination (including, in particular, the determination of the prothrombin index) is recommended so that, if necessary, the dose should be reviewed and the analyzes repeated, depending on the changes in the parameters.
Before the beginning of therapy, before surgery, with the appearance of bruising or spontaneous bleeding, a general blood test (including determination of the number of platelets, bleeding time and coagulogram parameters) is necessary.
If the symptomatology of the "acute" abdomen and such gastrointestinal symptoms as nausea, vomiting and / or anorexia occur against the background of treatment, it is necessary to determine the activity of amylase in the blood to exclude acute pancreatitis.With increased activity of pancreatic enzymes, the drug should be withdrawn, taking alternative therapeutic measures.
When using Valparin ® in patients with renal insufficiency, it is recommended to take into account the increased concentration of free form of valproic acid in the blood plasma and to reduce the dose.
If it is necessary to administer the drug to patients with systemic lupus erythematosus and other diseases of the immune system, the expected therapeutic effect and the possible risk of therapy should be evaluated, since in the case of Valparin ®, in very rare cases, violations of the immune system were noted.
It is not recommended to prescribe the drug to patients with a deficiency of urea enzymes. In such patients, several cases of hyperammonemia accompanied by a stupor and / or coma have been described.
During the treatment, it is not allowed to take drinks containing ethanol.
Patients should be warned about the risk of weight gain at the beginning of treatment and recommend compliance with the diet to minimize such effects.