Encorate Chrono 200

Description

Encorate Chrono 200 Tablet: Uses, Dosing, and Important Information

Encorate Chrono 200 Tablet contains Sodium Valproate (valproic acid), an anticonvulsant medication used to treat various seizure types, bipolar disorder, and to help prevent migraine headaches.

What Is Encorate Chrono 200 Used For?

Encorate Chrono 200 Tablet is used for:

• Epilepsy (Seizure Disorders):
  • Partial seizures (both simple and complex)
  • Absence seizures (petit mal seizures)
  • Generalized tonic-clonic seizures (grand mal seizures)
  • Myoclonic seizures
  • Atonic seizures
  • Mixed seizure types (including absence seizures)
• Bipolar Disorder: For the treatment of manic episodes.
• Migraine: For the prevention (prophylaxis) of migraine headaches (not for acute treatment).

It is also mentioned in the provided text for:

• Anxiety disorder
• Posttraumatic stress disorder
• Febrile convulsion
• Anorexia nervosa
• Panic attack However, the primary adult and child dose sections only detail epilepsy, migraine, and bipolar disorder.

Dosing Information

Always take Encorate Chrono 200 exactly as your doctor prescribes. Dosing is highly individualized.

Adult Dosing (Oral)

• Complex Partial Seizures (as monotherapy or add-on therapy):
  • Initial: 10-15 mg/kg per day.
  • Increase: By 5-10 mg/kg per day weekly.
  • Maximum: Up to 60 mg/kg per day.
• Simple & Complex Absence Seizures (as monotherapy or add-on therapy):
  • Initial: 15 mg/kg per day, divided into 2 or 4 doses (every 6-12 hours).
  • Increase: By 5-10 mg/kg per day weekly.
  • Maximum: Up to 60 mg/kg per day.
• Migraine Prophylaxis (prevention):
  • 250 mg twice daily (every 12 hours).
  • Adjust dose based on how well it works, but do not exceed 1000 mg (1 gram) per day.
• Bipolar Mania:
  • 750 mg per day, given in divided doses.
  • Adjust dose as quickly as possible to achieve the desired effect.
  • Maximum: Not to exceed 60 mg/kg per day.

Hepatic Impairment (Liver Problems)

• Mild to Moderate: Administer lower doses.
• Severe Impairment: This medication is contraindicated.

Child Dosing (Oral)

• Children under 10 years: Safety and effectiveness have not been established.
• Children 10 years and older:
  • Complex Partial Seizures (as monotherapy or add-on therapy):
    • Initial: 10-15 mg/kg per day.
    • Increase: By 5-10 mg/kg per day weekly.
    • Maximum: Up to 60 mg/kg per day.
  • Simple & Complex Absence Seizures (as sole or add-on therapy):
    • 250 mg twice daily (every 12 hours).
    • Adjust dose based on how well it works, but do not exceed 1000 mg (1 gram) per day.

Renal Impairment (Kidney Problems)

• No dosage adjustment is necessary for kidney impairment.

How to Take Encorate Chrono 200

• Encorate Chrono 200 Tablets can be taken with or without food.
• To help reduce stomach upset (GI side effects), it is often recommended to take this medication with meals, start with a low dose, or use enteric-coated formulations.

Important Warnings and Precautions

Do Not Use Encorate Chrono 200 If:

• You have a pre-existing or family history of hepatic (liver) dysfunction or active liver disease.
• You have porphyria (a group of rare genetic disorders).
• You have mitochondrial disorders or urea cycle disorders.
• You are pregnant.

Special Considerations:

• Liver Toxicity (Hepatotoxicity): Increased risk, especially in children under 2 years old, or those with congenital metabolic disorders, organic brain disease, or severe seizure disorders. Your doctor will monitor liver function tests (LFTs) before and during the first 6 months of therapy.
• Blood Disorders: Monitor complete blood counts (including platelet count), bleeding time, and coagulation tests before starting therapy, before any surgery, and if you experience unexplained bruising or bleeding.
• Hyperammonemic Encephalopathy: If you develop unexplained lethargy, vomiting, or changes in mental status, your doctor may suspect high ammonia levels in your blood and will measure them.
• Withdrawal: Do not stop taking this medication suddenly. It should be withdrawn gradually or transitioned to another antiepileptic therapy under medical supervision.
• Bone Health: If you are immobilized or have insufficient sun exposure or calcium intake, consider vitamin supplementation.
• Mental Health: Your doctor will monitor you for atypical behavior, including suicidal thoughts and behavior, during and after therapy.
• Pancreatitis: Seek medical advice immediately if you experience signs of pancreatitis (e.g., severe abdominal pain, nausea, vomiting, loss of appetite).
• HIV or CMV infection; SLE: Use with caution.
• Driving/Operating Machinery: This medication may impair your ability to drive or operate machinery.

Pregnancy and Lactation:

• Pregnancy: Encorate Chrono 200 is contraindicated during pregnancy due to potential risks to the fetus.
• Lactation (Breastfeeding): The drug is excreted in breast milk; therefore, it is generally not recommended for breastfeeding mothers. Use with caution and discuss with your doctor.

Possible Drug Interactions

Tell your doctor about all medications you are taking, including over-the-counter drugs and herbal supplements, as Encorate Chrono 200 can interact with them.

• Increased Risk of Toxicity/Side Effects:
  • Bupropion: Increased risk of toxicity.
  • Mefloquine: Increased risk of convulsions.
  • Pivmecillinam and Pivampicillin: Increased risk of carnitine deficiency.
  • Olanzepine: Increased risk of liver toxicity.
  • Topiramate: Increased risk of high ammonia levels (hyperammonaemia).
  • Highly Protein Bound Drugs: May increase free valproic acid concentrations.
  • Concurrent use with: Phenobarbital, nimodipine, nifedipine, lamotrigine, zidovudine, amitriptyline, nortriptyline, and benzodiazepines may lead to increased levels of these drugs.
• Altered Valproic Acid Levels:
  • Decreased Valproic Acid Levels with: Carbapenems (e.g., meropenem – potentially fatal interaction, concomitant use is not recommended), rifampicin, phenytoin, phenobarbital (or primidone), and certain antineoplastic (cancer) drug regimens.
  • Increased Valproic Acid Levels with: Felbamate and aspirin (avoid concurrent salicylates in children under 3 years due to liver toxicity risk).
• Other Interactions:
  • Ethosuximide: Decreased valproic acid levels and increased ethosuximide serum levels.
  • Carbamazepine: Increased risk of liver toxicity and carbamazepine toxicity, with a decrease in valproic acid levels.
  • Tigabine and Clozapine: Concurrent use may decrease levels of these drugs.
  • Clonazepam: Increased risk of absence status (a type of seizure).

Potentially Fatal Interactions:

• Carbapenems: Concomitant use is not recommended as it can significantly decrease valproate levels, leading to loss of seizure control.
• Salicylates (Aspirin): Avoid concurrent use in children under 3 years due to a significant risk of liver toxicity.
• Cosyntropin: Increased risk of liver toxicity.
• Ethanol (Alcohol): Avoid as it may increase central nervous system (CNS) depression.

Possible Side Effects

Like all medicines, Encorate Chrono 200 can cause side effects. Some are common and mild, while others can be serious. If you experience any severe or concerning side effects, contact your doctor immediately.

• Very Common (>10%):
  • Nausea (31%), Headache (<31%), Increased bleeding time (26-30%), Thrombocytopenia (low platelets) (26-30%), Tremor (25%), Hair loss (alopecia) (<24%), Weakness (asthenia) (16-20%), Infection (16-20%), Drowsiness (somnolence) (16-20%), Blurred vision (amblyopia) (11-15%), Diarrhea (11-15%), Double vision (diplopia) (11-15%), Dizziness (11-15%), Indigestion (dyspepsia) (11-15%), Involuntary eye movements (nystagmus) (11-15%), Ringing in ears (tinnitus) (11-15%), Vomiting (11-15%).
• Common (1-10%):
  • Lack of coordination (ataxia) (<8%), Increased appetite (<6%), Rash (<6%), Abdominal pain (<5%), Tremor (<5%), Back pain (<5%), Mood changes (<5%), Anxiety (<5%), Confusion (<5%), Abnormal walking (gait) (<5%), Numbness/tingling (paresthesia) (<5%), Hallucinations (<5%), Catatonia (<5%), Difficulty speaking (dysarthria) (<5%), Involuntary repetitive movements (tardive dyskinesia) (<5%), Vertigo (<5%), Irregular menstrual periods (<5%), Weight gain (4%).
• Frequency Not Defined (less common but reported):
  • Anorexia (loss of appetite), Acute pancreatitis (inflammation of the pancreas, can be life-threatening), Hepatic toxicity (liver damage), Hyperammonemia (high blood ammonia levels), Weight loss, Fractures, Osteoporosis (bone thinning), Osteopenia (reduced bone density), Decreased bone mineral density, Cerebral pseudoatrophy (apparent brain shrinkage).

Potentially Fatal Side Effects:

• Acute pancreatitis (can be life-threatening).
• Hepatic toxicity (severe liver damage).
• Myelosuppression (bone marrow suppression, affecting blood cell production).
• Stevens-Johnson syndrome (severe skin reaction).
• Toxic epidermal necrolysis (more severe form of SJS).
• Blood dyscrasias such as neutropenia or thrombocytopenia (very low white blood cell or platelet counts).

How Encorate Chrono 200 Works

Valproate is a general term for valproic acid and its related compounds. It is a carboxylic acid anticonvulsant. While its exact mechanism isn’t fully understood, its anti-seizure (antiepileptic) activity is thought to be related to an increase in the levels of gamma-aminobutyric acid (GABA) in the brain. GABA is a neurotransmitter that helps to calm excessive electrical activity in the brain, thereby reducing seizures.

Note: This information about Encorate Chrono 200mg Tablet, manufactured by Sun Pharmaceutical Industries Ltd. (generic name: Sodium Valproate (valproic acid)), is available in Nepal. This drug index information is for general knowledge only and is not intended for diagnosis, medical advice, or treatment. It should never replace the professional judgment of a healthcare provider. Always consult your doctor or pharmacist for medical advice specific to your condition.