Medicine overview
Indications of Eval CR 300 mg
Sodium Vaiproate oral is indicated for the treatment of all types of epilepsy, e.g. Partial seizures Absence seizures (petit mal) Generalized tonic-clonic seizures (grand mal) Myoclonic seizures Atonic seizures Mixed seizures that include absence attack ... Read moreSodium Vaiproate oral is indicated for the treatment of all types of epilepsy, e.g. Partial seizures Absence seizures (petit mal) Generalized tonic-clonic seizures (grand mal) Myoclonic seizures Atonic seizures Mixed seizures that include absence attack Prophylaxis of febrile convulsion Prophylaxis of post-traumatic epilepsy. It is also indicated in the treatment of bipolar disorder and prophylaxis of migraine.

Composition
Eval CR 300 mg tablet: Each enteric-coated tablet contains Eval CR 300 mg BP 200 mg.Eval CR 300 mg syrup: Each 5 ml syrup contains Eval CR 300 mg BP 200 mg.Eval CR 300 mg controlled release 200 tablet: Each enteric-coated controlled release tablet contains Eval CR 300 mg 200 mg as Eval CR 300 mg BP 133.2 mg and Valproic acid BP 58 mg.Eval CR 300 mg controlled release 300 tablet: Each enteric-coated controlled release tablet contains Eval CR 300 mg 300 mg as Eval CR 300 mg BP 199.8 mg and Valproic acid BP 87 mg.Eval CR 300 mg controlled release 500 tablet: Each enteric-coated controlled release tablet contains Eval CR 300 mg 500 mg as Eval CR 300 mg BP 333 mg and Valproic acid BP 145 mg.Eval CR 300 mg injection: Each 5 ml injectable solution contains Eval CR 300 mg BP eqv. to Valproic Acid 500 mg.

Theropeutic Class
Primary anti-epileptic drugs

Pharmacology
Eval CR 300 mg shows antiepileptic properties in various types of seizures. The exact mechanism of Eval CR 300 mg is not yet established. However it is suggested that its activity is related to increased brain levels of Gama Amino Butyric Acid (GABA).

Dosage and Administration of Eval CR 300 mg
Adults: Initial: 600 mg/ day in 2 divided doses, preferably after food. Dose may be increased by 200 mg/day at 3 days interval to a maximum of 2.5 gm daily in divided doses until control of seizure is achieved. Maintenance dose:Usually 1-2 gm daily (20-30 mg/ kg daily). Children (up to 20 kg): Initial: 20 mg/kg daily in divided doses. Dose may be increased in severe cases with proper monitoring of plasma concentration. Children (over 20 kg): Initial: 400 mg/ day (irrespective of weight). Dose may be increased by 20-30 mg/ kg if required to achieve control.

Dosage of Eval CR 300 mg
Oral: Eval CR 300 mg 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 percent Sodium Chloride injection, 5 percent Dextrose injection.

Interaction of Eval CR 300 mg
Sodium Vaiproate appears to act as a non specific inhibitor of drug metabolism. Drugs to which it interacts most significantly are Phenobarbital, Phenytoin, Warfarin, Aspirin etc.

Contraindications
Eval CR 300 mg is contraindicated to patients who have known hypersensitivity to the drug and liver dysfunction. Use of Eval CR 300 mg is restricted during pregnancy and in women of childbearing potential.

Side Effects of Eval CR 300 mg
The most common side effects are anorexia, nausea and vomiting. However, these side effects are minimized with the use of enteric coated tablets. Effects on the CNS include sedation, ataxia and tremor. These symptoms occur infrequently and usually respond to a decrease in doses. Rash, alopecia and stimulation of appetite have been observed occasionally. Sodium Vaiproate has several effects on hepatic function of which elevation of liver enzymes in plasma is observed in up to 40 percent of patients and often occurs asymptomatically during the first few months of therapy. Rarely a fulminate hepatitis that may be fatal may develop. Children below 2 years of age with other medical conditions and those being treated with multiple antiepileptic agents are specially prone to suffer from hepatic injury, acute pancreatitis and hyperammonemia have also been frequently associated with the use of Eval CR 300 mg.

Pregnancy and Lactation
Eval CR 300 mg crosses the placenta in humans which may lead to neural tube defects such as anencephaly and spina bifida if exposed in the first trimester. Eval CR 300 mg may excrete in breast milk. So treatment with Eval CR 300 mg may cause harm to new born baby.

Precautions and Warnings
Liver functions should be monitored before therapy and during first 6 months especially in patients most at risk, No undue potential for bleeding before starting and before major surgery must be ensured, Care should be taken in renal impairment, pregnancy, breast-feeding and systemic lupus erythematosus. Eval CR 300 mg is partially eliminated in the urine as a ketone metabolite, which may lead to a false interpretation of the urine ketone test. Sudden withdrawal of therapy should be avoided. Eval CR 300 mg should not be used during pregnancy and in women of childbearing potential.

Storage Conditions
Do not store above 30°C. Keep away from light and out of the reach of children.

Drug Classes
Primary anti-epileptic drugs

Mode Of Action
Eval CR 300 mg, the active ingredient of this preparation is endowed with anti-epileptic activity against a variety of seizures. The mechanism by which Eval CR 300 mg exerts its anti-epileptic effects has not been established. However, it has been suggested that its activity is related to increase brain levels of gamma-aminobutyric acid (GABA).

Pregnancy
Sodium Vaiproate crosses the placenta and in humans, exposure to valproate in the first trimester has been associated with neural tube defects such as anencephaly and spina bifida in newborn. Pregnant women treated with Sodium Vaiproate should be offered to estimate serum a-fetoprotein. Eval CR 300 mg is excreted in breast miik. However, breast-feeding by a mother taking Eval CR 300 mg probably causes no risk to the child.