Epival 250mg/5ml Syrup 120 ml

Description

About

Epival 250mg/5ml Syrup 120 ml belongs to a class of drugs called anticonvulsants, used to treat conditions like epilepsy and depression, extreme mood swings, or mania associated with bipolar disorder, acting as a mood stabilizer and in the prevention of migraine episodes.  Epival 250mg/5ml Syrup 120 ml is chemically composed of Divalproex Sodium, available as oral tablets, syrups, or suspension of varying potencies. Epival 250mg/5ml Syrup 120 ml may be used as an adjunct, supplementing the therapeutic effects of other anticonvulsant agents or it can be used alone to treat the condition. It can be used for the long-term management of seizures. 

Divalproex sodium contained in the Epival 250mg/5ml Syrup 120 ml imposes an inhibitory action on neurotransmitters which normally induces an excitatory response by blocking high voltage-activated calcium channels and voltage-gated sodium channels as well as increasing the action of GABA. It inhibits signal transmission and uncontrolled/ abnormal activities of the brain. It reduces neuronal transmission and subsequently slows down the excitability of neurons in the brain. It can take 1 to 2 weeks for Epival 250mg/5ml Syrup 120 ml to start showing full effects. This medicine is known to cause serious birth defects in unborn babies. Therefore, if you are pregnant and breastfeeding, avoid using it without a doctor’s advice. Also, abrupt withdrawal of Epival 250mg/5ml Syrup 120 ml can cause exacerbation of symptoms, for which reason you must consult a doctor first

Epival 250mg/5ml Syrup 120 ml is available in a more suited formulation for children as oral liquid (syrup and suspension) on prescription to be swallowed via mouth with a glass of water, usually in prescribed doses. While Epival 250mg/5ml Syrup 120 ml can be prescribed to children aged 10 years and adults alike, children, less than 10 years must be strictly monitored and supervised since safety is a big concern in younger children. Children, less than 2 years are not to be treated with this medicine. The dosage of Epival 250mg/5ml Syrup 120 ml depends on weight, age, the severity of the condition, patient’s response to the medicine, and their comorbidities as well as the type of formulation (with regards to its release mechanism) being used. Epival 250mg/5ml Syrup 120 ml is started in low doses which are increased with careful monitoring. The most common side effects of this medication are nausea, headache, and dizziness, mood changes.

Indications

Epival 250mg/5ml Syrup 120 ml is prescribed to adults and children (10and above) and it is used in the treatment of:

• Epilepsy and simple and complex seizure types such as absence/petit mal seizure
• Partial seizures 
• A bipolar disorder associated with depression/mood changes
• Mania 
• Migraine

How does Epival 250mg/5ml Syrup 120 ml work?

Epival 250mg/5ml Syrup 120 ml helps control seizures by controlling nerve impulses. Divalproex contained in the Epival 250mg/5ml Syrup 120 ml imposes an inhibitory action on excitatory neurotransmitters by blocking high voltage-activated calcium channels and voltage-gated sodium channels inhibiting glutamate release, a naturally occurring neurotransmitter inducing excitatory response. It also promotes the action of GABA by acting on its receptors, assisting its activity, and increasing these inhibitory transmitters in the brain. Thereby, it blocks/slows down signal transmission and uncontrolled/ abnormal activities of the brain.

How to use Epival 250mg/5ml Syrup 120 ml?

Epival 250mg/5ml Syrup 120 ml is available in the form of oral syrup and suspension to be taken by mouth. Swallow the solution with a glass of water as prescribed by the doctor usually once or twice a day, the dose being dependent on weight, age, the severity of the condition, patient’s response to the medicine, and their comorbidities as well as any other anticonvulsant being taken as an adjunct. Make sure to follow the doctor’s advice carefully regarding dosage and proper use. Syrup and suspension forms are packaged in a glass bottle. Make sure to shake the bottle vigorously if you are using the suspension form. 

In general, the treatment with Epival 250mg/5ml Syrup 120 ml is started at a relatively low dose that can give clinical results, which can be increased in potency and over weeks in increments as the need arises. Do not use household spoons to measure the syrup dose. A calibrated spoon/cup is available with ‌Epival 250mg/5ml Syrup 120 ml for dosing purposes. Alternatively, a  device or syringe can be bought from a pharmacy, which can be used after removing the needle.

Available Potency of Epival 250mg/5ml Syrup 120 ml 

Epival 250mg/5ml Syrup 120 ml  is available in tablet form in the following potencies:

• 250 mg/ 5 ml – Syrup 

Dosage

Adult Dose

Adult patients are generally prescribed oral tablets. Check the relevant product for details

Child Dose

For epilepsy and seizures, Epival 250mg/5ml Syrup 120 ml can be safely given to children aged 10 years and above. Younger children must not be treated with Epival 250mg/5ml Syrup 120 ml since there is not enough safety data available, if it is prescribed strict monitoring is advised due to a high risk of toxic effects on the liver and pancreas.

Starting dose: 10 – 15 mg/kg/day orally once or in divided dose according to the total calculated dose

Gradually increase by 5 -10 mg/kg per week to get the desired clinical outcome within safe limits

Maximum safe dose per day: 60 mg/kg/day orally

If the daily dose is less than or equal to 250 mg, it can be given as a single dose, dosage amounting to more than 250 mg can be given orally in divided doses commonly twice a day

Elderly dose

The elderly age group is always prescribed tablet form usually. The safety concerns of Epival 250mg/5ml Syrup 120 ml in the elderly population are still valid, hence caution must be taken. Your doctor should set the most appropriate dose for you based on your medical history. Doses are adjusted according to a liver impairment or other medications being taken concurrently, or other serious conditions. 

*Special Doses

Liver disease – Lower doses are advised along with monitoring of LFTs

Adjunct therapy with other anti-seizure may also require lowering the dose, your doctor will set the most appropriate dose for you

Pregnancy use and lactation

Epival 250mg/5ml Syrup 120 ml is FDA pregnancy risk category D (harmful to the fetus), therefore if you are pregnant, think you may be pregnant, or are planning to have a baby, please consult your doctor. Also Epival 250mg/5ml Syrup 120 ml is secreted into human milk, if you are breastfeeding, please consult your doctor before taking it.

Contraindications

Please inform your doctor if you have a history of any before using Epival 250mg/5ml Syrup 120 ml:

• Allergic reaction to Epival 250mg/5ml Syrup 120 ml or similar anticonvulsants
• Chronic liver disease with severe impairment of liver function
• Mitochondrial Disorders
• Disorders of urea cycle
• Concurrently with certain drugs (see drug interactions)
• Genetic conditions like Porphyria
• Pancreatitis 

Precautions‌ ‌

Please‌ ‌tell‌ ‌your‌ ‌doctor‌ ‌about‌ ‌any‌ ‌of‌ ‌the‌ ‌following‌ ‌conditions‌ ‌before using the ‌Epival 250mg/5ml Syrup 120 ml:‌ ‌

• A history of allergy to any or similar medicines 

• Liver and pancreas toxicity is of particular concern in younger children. Keen monitoring and caution are advised ‌Epival 250mg/5ml Syrup 120 ml

• In the case of liver disease before starting the treatment with ‌Epival 250mg/5ml Syrup 120 ml check LFTs, which must be monitored during the treatment as well. In case of severe liver inadequacy, this drug is prohibited

• Underage children less than 2 years of age are a high-risk category for suffering from serious side effects

• Women of fertile age group or those wanting to conceive/ or are pregnant must not use this medicine since it is associated with serious birth defects

• Strict long-term contraception is advised if you are using Epival 250mg/5ml Syrup 120 ml  to avoid pregnancy such as IUD/Coil, etc.

• Any pre-existing heart condition must also be discussed with your doctor

• Elderly patients (65 years and above) should exercise caution since Epival 250mg/5ml Syrup 120 ml has scanty data available regarding safety, also it can cause dizziness and fainting spells, dose adjustment may be done by the doctor

• Epival 250mg/5ml Syrup 120 ml must not be given to the patients with a history of recent head trauma

• The drug must not be stopped abruptly even if your symptoms have improved since it can produce worsening symptoms. Always ask a doctor before stopping

• Tolerance is also common with ‌Epival 250mg/5ml Syrup 120 ml where one may not feel clinical benefits the same as before. Do not add on to your dose without consulting a doctor first

• Epival 250mg/5ml Syrup 120 ml may alter the results of certain blood/urine tests like thyroid function, and ketone bodies in urine. Always tell your doctor n laboratory personnel about your current medicines

• Alteration in blood cell count like platelets (thrombocytopenia) can occur when Epival 250mg/5ml Syrup 120 ml reaches a certain level in the blood. Report to your doctor if you notice abnormal bleeding patterns or bruises 

• Epival 250mg/5ml Syrup 120 ml causes slowing down of brain function, alcohol consumption must be avoided with it

Interaction with other medications

Certain medications could interact with Epival 250mg/5ml Syrup 120 ml and may increase or decrease its absorption, in which case, your doctor might alter your dosage. A few of these interacting drugs are given below:

• Acetylsalicylic acid

• Amitriptyline/Non-nortriptyline

• Antivirals like ritonavir, lopinavir 

• Benzodiazepines  

• Carbapenem antibiotics

• Cholestyramine 

• Cimetidine 

• Clonazepam 

• Ethosuximide 

• Lamotrigine 

• Haloperidol 

• Propofol 

• Phenobarbital 

• Phenytoin

• Some oral contraceptives (not enough proof available)

• Rifampin 

• SSRI antidepressants 

• Warfarin 

Adverse effects

Like most medicines, Epival 250mg/5ml Syrup 120 ml has some side effects which include:

Common Side effects

• Nausea 

• Headache 

• Skin rash 

• Drowsiness 

• Dizziness

• Weight gain 

Rare side effects

• Anaphylactic reaction 

• Blurred vision

• Swollen gums 

• Dry mouth 

• Oral ulcers

• Uncontrolled muscle movements/ seizures 

• Itching/redness of eyes 

• Increased ammonium levels in the blood

• Increased hair fall

• Palpitations 

• Somnolence 

• Shaky hands/tremors  

• Altered blood cell count

• Menstrual cycle irregularities 

• Acute pancreatitis 

• Liver/Pancreas toxicity 

• Abnormal bleeding

• Unexplained bruises 

• Erectile dysfunction

• Loss of libido 

LIST OF HOW TO DEAL WITH ADVERSE EFFECTS

Dry Mouth – Can be helped by sipping water throughout the day, chewing sugarless gum, using alcohol-free mouthwash, allowing ice to melt in the mouth, or using a saliva substitute.

Fatigue – Patients experiencing this adverse effect are advised to take deep breaths, intake tea or coffee, get a good night’s rest, and not overburden themselves for a few days.

Feeling drowsy – If the medication makes you feel drowsy or sleepy, stop what you’re doing and sit or lie down until you feel better, and do not rise too fast or immediately from a sitting or lying down position to a standing posture. Do not drive or use tools or machinery in case of any of these effects.

Headaches – In which case make sure you rest and drink plenty of fluids. Avoid the use of alcohol. Take a prescribed painkiller. Consult your doctor if the headaches last longer than a week or are severe

Feeling or being sick (nausea or vomiting) or diarrhea – Avoid eating rich or spicy food. It might help to take medication after food. If you’re sick, try drinking small, frequent sips of water. 

Feeling dizzy (lightheaded) or weak –If the medication makes you feel dizzy or weak, stop what you’re doing and sit or lie down until you feel better, and do not rise too fast or immediately from sitting or lying down position to a standing posture. Do not drive or use tools or machinery in case of any of these effects.

Muscular Aches and Pains- A hot or cold compress can be placed at the area of discomfort to bring relief; an over-the-counter pain reliever such as paracetamol or ibuprofen can be ingested to bring ease as well. Avoid high-intensity exercise while suffering from muscular pain.

Flatulence- Can be eased by consuming smaller, more frequent meals that don’t trigger your flatulence. Getting a minimum of 30 minutes of daily exercise has shown great results in combating flatulence. 

Heartburn – can be dealt with by chewing on mint-flavored gum that’ll help neutralize the acid in the body. Standing up straighter, adding ginger to the daily diet, elevating the patient’s upper body, and having licorice supplements has shown to provide relief.

Skin Rash- can be eased by applying soothing and healing lotions or creams such as calamine lotion/cream. Apply a cold compress to the rash helps reduce itchiness and redness caused by the rash. An antihistamine (prescribed by a doctor) is also recommended as an effective way to combat any skin rash.

Dehydration- Patients are recommended to always care around a water bottle with them wherever they go and periodically keep sipping to prevent thirst and extremely dry mouth. Ice pops in hot weather and energy drinks (verified by the doctor) help combat dehydration.

Fever – patients are asked to ingest over the counter painkillers (such as Paracetamol), partake in plenty of fluids, and rest for a couple of days till the symptoms pass

FAQs

#1. WHAT EXACTLY DOES Epival 250mg/5ml Syrup 120 ml DO?

It is an anticonvulsant used to treat complex and partial seizures, symptoms of mania in bipolar disorder inhibiting signal transmission in the brain producing excitation and as a result uncontrolled movement

#2. HOW LONG DOES IT TAKE FOR Epival 250mg/5ml Syrup 120 ml TO START WORKING?

Normally it takes 2 weeks or more for Epival 250mg/5ml Syrup 120 ml to show its full effects.

#3. HOW LONG WILL I HAVE TO TAKE Epival 250mg/5ml Syrup 120 ml FOR?

Time duration depends on why you’re taking Epival 250mg/5ml Syrup 120 ml. Consult your physician for this, Epival 250mg/5ml Syrup 120 ml can be taken for longer periods from 1 to 3 weeks or more for epilepsy. 

#4. CAN I STOP TAKING Epival 250mg/5ml Syrup 120 ml?

Do not just stop taking the medicine, make sure to complete your treatment course even if you feel better. Stopping it suddenly may cause exacerbation of symptoms, having said that it is not addicting.

#5. IS Epival 250mg/5ml Syrup 120 ml HIGHLY ADDICTIVE?

No, it is not considered to be addictive and does not cause dependence but stopping the medicine abruptly can cause undesirable adverse symptoms.

#6. CAN I DRINK ALCOHOL WITH Epival 250mg/5ml Syrup 120 ml?

Consuming alcohol when taking Epival 250mg/5ml Syrup 120 ml may cause excessive drowsiness and could increase the risk of liver damage, hence should be avoided. 

#7. WHAT IF I TAKE TOO MUCH OF Epival 250mg/5ml Syrup 120 ml?

If you have taken too much of the prescribed Epival 250mg/5ml Syrup 120 ml you may experience symptoms of toxicity which will vary depending on the dose ingested, for example, fast pounding, irregular heartbeat, upset stomach, blurred vision, fainting, dizziness, seizures, or life-threatening severe symptoms. Contact your doctor or emergency immediately if you have any of these symptoms. 

#8. WHAT IF I FORGET TO TAKE Epival 250mg/5ml Syrup 120 ml?

Epival 250mg/5ml Syrup 120 ml is taken once or twice a day so you can take the missed dose as soon as you remember unless it’s about time until your next dose, in which case you should skip the missed dose. If it helps to remind you, set an alarm or use a pill organizer or a mobile application so you do not miss any dose. Make sure to complete your course of treatment even if you feel better and think you do not need to take it anymore.

#9. CAN I TAKE Epival 250mg/5ml Syrup 120 ml DURING PREGNANCY OR BREASTFEEDING?

Epival 250mg/5ml Syrup 120 ml has a safety concern for unborn babies and is known to cause serious defects in these babies. If you are pregnant, think you may be pregnant, or are planning to conceive a baby, please consult your doctor before using Epival 250mg/5ml Syrup 120 ml. If you are breastfeeding, please consult your doctor before taking Epival 250mg/5ml Syrup 120 ml. Foolproof contraception is advised when you are using Epival 250mg/5ml Syrup 120 ml to avoid pregnancy.

#10. CAN I DRIVE OR RIDE A BIKE AFTER TAKING Epival 250mg/5ml Syrup 120 ml?

Usually  Epival 250mg/5ml Syrup 120 ml  is known to cause drowsiness and dizziness so make sure you know how your body reacts while using ‘product’. Do not drive or use any sharp or heavy machinery until you feel normal again.

#11. HOW SHOULD Epival 250mg/5ml Syrup 120 ml BE STORED?

Store it at room temperature below 30 °C, away from excess heat, direct sunlight, and moisture. Make sure it is not consumed by pets, children, and other people. Dispose of the unused medicine. 

#12. CAN Epival 250mg/5ml Syrup 120 ml AFFECT MY SEXUAL ACTIVITY?

Sexual dysfunction may occur with Epival 250mg/5ml Syrup 120 ml in some patients. It may cause a decrease in libido or cause erection problems in some patients. You must discuss this with your consultant before starting. 

#13. CAN Epival 250mg/5ml Syrup 120 ml AFFECT MY ORAL CONTRACEPTION?

No, oral contraceptives are not known to interact with Epival 250mg/5ml Syrup 120 ml.

#14. WILL  Epival 250mg/5ml Syrup 120 ml AFFECT MY FERTILITY?

Epival 250mg/5ml Syrup 120 ml has been reported to decrease fertility in some patients, however, this is reversible and returns to normal once your therapy ends. Problems like irregularities in menses, erectile dysfunction, and loss of libido all have an impact.

#15. WILL I HAVE TO TAKE OTHER EPILEPSY MEDICINES WITH Epival 250mg/5ml Syrup 120 ml? 

Epival 250mg/5ml Syrup 120 ml may or may not be used in combination with other anticonvulsants depending on your condition and response. Dose adjustment is done accordingly if more than one type of anticonvulsant is being taken together.