From the Guidelines
Valproate is primarily used to treat epilepsy, bipolar disorder, and migraine headaches, with its most recent and highest quality use being as a preventive treatment for episodic migraine headache in nonpregnant adults, as suggested by the American College of Physicians in 2025 1.
Uses of Valproate
- Epilepsy: valproate works as an anticonvulsant to control various types of seizures, including absence, myoclonic, and tonic-clonic seizures, with IV valproate being an acceptable treatment option for refractory status epilepticus, as shown in a study published in the Annals of Emergency Medicine in 2014 1.
- Bipolar disorder: valproate serves as a mood stabilizer to manage manic episodes and prevent mood swings, with lithium or valproate recommended for maintenance treatment of bipolar disorder, as stated in the evidence-based guidelines for mental, neurological, and substance use disorders in low- and middle-income countries in 2011 1.
- Migraine headaches: valproate is used as a preventive treatment to reduce the frequency and severity of headaches, with the American College of Physicians suggesting its use before trying more costly medications like CGRP-mAbs or CGRP antagonist-gepants in 2025 1.
Mechanism of Action and Side Effects
Valproate works by increasing levels of gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter in the brain, and by blocking sodium channels, which helps reduce excessive neuronal firing. Common side effects include nausea, tremor, weight gain, hair loss, and sedation. Important safety concerns include potential liver damage, pancreatitis, and serious birth defects, making it contraindicated in pregnancy. Regular monitoring of liver function, blood counts, and drug levels is essential during treatment.
Dosage and Administration
Typical dosing ranges from 500-2000 mg daily, often divided into multiple doses, with blood level monitoring required to maintain therapeutic levels (50-100 μg/mL). The dosage and administration may vary depending on the specific condition being treated and the patient's response to the medication.
From the FDA Drug Label
Valproic acid is indicated as monotherapy and adjunctive therapy in complex partial seizures in adults and pediatric patients down to the age of 10 years, and in simple and complex absence seizures. Valproic acid is indicated as monotherapy and adjunctive therapy in the treatment of patients with complex partial seizures that occur either in isolation or in association with other types of seizures. Valproic acid is indicated for use as sole and adjunctive therapy in the treatment of simple and complex absence seizures, and adjunctively in patients with multiple seizure types which include absence seizures.
Valproate is used for the treatment of:
- Complex partial seizures in adults and pediatric patients
- Simple and complex absence seizures
- Multiple seizure types which include absence seizures 2 2
From the Research
Uses of Valproate
- Valproate is used for the preventive treatment of migraine 3, 4
- It is effective in managing status epilepticus, migraines, and manic episodes of bipolar disorder in conjunction with lithium 4
- Valproate has been used for the treatment of a variety of neuropsychiatric illnesses, including bipolar disorder and epilepsy 5, 6, 7
- It is used as a mood-stabilizer for bipolar disorder 6, 7
- Valproate is also used to treat generalized and focal epilepsy 4