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Is It Safe To Lower Valproic Acid Dosage Without Doctor's Consultation?

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Posted on Fri, 1 Jul 2016
Question: Hello, Dr Sheppe, I am XXXX XXXXXXX XXXX, and I wrote you recently about Propranolol for anxiety.

I have been a psychiatric patient for 15 years now, and in 2010, my diagnosis was changed from that of Schizophrenia, in 2001, to Schizoaffective bipolar disorder in 2010.

The medicine that I was prescribed was Valproic Acid, because the tablets were too big for me swollow. I asked for something easier to swollow after first taking the three very large tablets once a day, to Valproic Acid Syrup, 5ml 3 times daily, which is what I take now, or did, just before going to psychiatric hospital for anxiety attack on March 14, 2016. After seeing a doctor, he removed one medicine, Welbutrin, which I had been taking for two years... that medicine I questioned why it was prescribed in first place. But nonetheless, without Welbutrin since March 14, stopped in hospital, I have not had anxiety as before, which was very severe a few months before going to hospital... I entered hospital voluntarily and asked to go middle of day, was beautiful day, but I was very nervous that day.

What the doctor did a psychiatric hospital, as well, was increase Valproic Acid to 10ml from my previously prescribed 5ml. Before the 5ml prescription just a few months before, it was 2.5ml 3 times daily of Valproic Acid, which had been dropped for a period of time because of my better health. The reason it was changed - increased to 5ml of Valproic Acid 3 times daily, was because the doctor said it was the least effective dosage possible for that medicine to have any effect. That 2.5ml was too low a dosage of Valproic acid to take effect.

What I am writing you is that I have been sick with the 10ml dossage of Valproic Acid 3 times daily. I have bad headache, and other symptoms that don't let me function normally. I had to decrease to 5ml dossage immediately and thankfully I feel much better again. I tried the 10ml dossage for a long time. I tried 2 to 3 times, and every time I get the symptoms. I know it has something to do with the Valproic Acid syrup medicine.

I told my psychologist today and he told me to tell the nurse that administers my injection. I take Risperdal consta injection 50mg once every two 2 weeks, and Risperdone tablet. These, in total are my only medicines.

The psychologist I see told me to keep taking the dosage I lowered, and he asked me if I felt headaches I told him no, after my voluntary change of dosage. The psychologist said it was good that I don't have headaches anymore.

They made an appointment for me for tomorrow to see a nurse practitioner about my change in dosage of Valproic Acid.

I just write to comment on my situation. I realize I should not change dosage of medicine without a directive from a doctor, but symptom was painful for me. Luckily I will see nurse practitioner soon. I am just scared because as a psychiatric patient I don't have the right or permission to change or stop my medicine without the consent and directive of a prescribing doctor for psychiatric medicine.

Thank you for taking the time to listen to me Dr Sheppe. I just write you to ask your viewpoint and any advice you may have for me. I am usually a calm person keep to my things but sometimes I like to talk and be open with people, too.
doctor
Answered by Dr. Alexander H. Sheppe (1 hour later)
Brief Answer:
Private Consultation

Detailed Answer:
Hello XXXXX, and thanks so much for reaching out to talk to me.

You're right about only changing medications under the supervision of a doctor, but I think in this case you handled it very well. You immediately sought help and re-consultation as soon as you were having side effects, so the lower dose should not be a problem for these short few days. I think you did the right thing. Sometimes valproic acid can have side effects such as headache. This medication is dosed according to blood levels. Your doctor or NP will probably check a medication level in your blood to make sure it is not too high. Another thing you can consider is the valproic acid sprinkle formulation. It literally comes in little sprinkles you can put into food. This might cause fewer side effects than the liquid formulation.

As a side note, I visited your website that you linked me to, and it is very interesting. You have traveled a lot and must have a very good relationship with your family. I liked all the old pictures.

Please feel free to reach out to me at any time for advice and support. I very much look forward to working with you more in the future!

Please remember to rate and close this answer thread when you are finished and satisfied.

tinyurl.com/DrSheppeAnswers

Dr. Sheppe
Note: For further follow up on related General & Family Physician Click here.

Above answer was peer-reviewed by : Dr. Arnab Banerjee
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Answered by
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Dr. Alexander H. Sheppe

Psychiatrist

Practicing since :2014

Answered : 2236 Questions

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Is It Safe To Lower Valproic Acid Dosage Without Doctor's Consultation?

Brief Answer: Private Consultation Detailed Answer: Hello XXXXX, and thanks so much for reaching out to talk to me. You're right about only changing medications under the supervision of a doctor, but I think in this case you handled it very well. You immediately sought help and re-consultation as soon as you were having side effects, so the lower dose should not be a problem for these short few days. I think you did the right thing. Sometimes valproic acid can have side effects such as headache. This medication is dosed according to blood levels. Your doctor or NP will probably check a medication level in your blood to make sure it is not too high. Another thing you can consider is the valproic acid sprinkle formulation. It literally comes in little sprinkles you can put into food. This might cause fewer side effects than the liquid formulation. As a side note, I visited your website that you linked me to, and it is very interesting. You have traveled a lot and must have a very good relationship with your family. I liked all the old pictures. Please feel free to reach out to me at any time for advice and support. I very much look forward to working with you more in the future! Please remember to rate and close this answer thread when you are finished and satisfied. tinyurl.com/DrSheppeAnswers Dr. Sheppe