Epifri Dosage/Direction for Use

Valproic acid syrup is administered orally. The recommended initial dose is 15 mg/kg/day, increasing at one week intervals by 5-10 mg/kg/day, until seizures are controlled or side effects preclude further increases. The maximum recommended dose is 60 mg/kg/day. If the total daily dose exceeds 250 mg, it should be given in a divided regimen.
The following table is a guide for the initial daily dose of valproic acid (15 mg/kg/day): See table.


Click on icon to see table/diagram/image


The frequency of adverse effects (particularly elevated liver enzymes) may be dose-related. The benefit of improved seizure control which may accompany the higher doses should therefore be weighed against the possibility of a greater incidence of adverse reactions.
A good correlation has not been established between daily dose, serum level and therapeutic effect. However, therapeutic serum levels for most patients will range from 50 to 100 mcg/ml. Occasional patients may be controlled with serum levels lower or higher than this range.
As the valproic acid syrup dosage is titrated upward, blood levels of phenobarbital and/or phenytoin may be affected.
Gastrointestinal Irritation: Patients who experience gastrointestinal irritation may benefit from administration of the drug with food or by slowly building up the dose from an initial low level.