Epilim (Sodium Valproate)

Epilim 100mg Crushable Tablets. Sodium Valproate

What Epilim Crushable is and what it is used for

What Epilim Crushable is

The name of your medicine is Epilim 100mg Crushable Tablets. What Epilim Crushable contains

Epilim Crushable contains a medicine called sodium valproate. It belongs to a group of medicines called anti-convulsants or anti-epileptic agents. It works by helping to calm the brain down.

What Epilim Crushable is used for

It is used to treat epilepsy (fits) in adults and children.

Before you take Epilim Crushable

Do not take Epilim Crushable and tell your doctor if:

• You are allergic (hypersensitive) to sodium valproate or any of the other ingredients of Epilim Crushable
• Signs of an allergic reaction include: a rash, swallowing or breathing problems, swelling of your lips, face, throat or tongue
• You have liver problems or you or your family have a history of liver problems
• You have a rare illness called porphyria

Do not take this medicine if any of the above apply to you. If you are not sure, talk to your doctor or pharmacist before taking Epilim Crushable.

Take special care with Epilim Crushable

A small number of people being treated with anti-epileptics such as sodium valproate have had thoughts of harming or killing themselves. If at any time you have these thoughts, immediately contact your doctor.

Check with your doctor or pharmacist before taking this medicine if:

• You have diabetes. This medicine may affect the results of urine tests.
• You have kidney problems. Your doctor may give you a lower dose
• You have fits (epilepsy), brain disease or a metabolic condition affecting your brain
• You have a ‘urea cycle disorder’ where too much ammonia builds up in the body.
• You have an illness called “systemic lupus erythematosus (SLE)” -a disease of the immune system which affects skin, bones, joints and internal organs

If you are not sure if any of the above apply to you, talk to your doctor or pharmacist before taking Epilim Crushable.

Weight gain

Taking Epilim Crushable may make you put on weight. Talk to your doctor about how this will affect you.

Blood tests

Your doctor may wish to do blood tests before you start taking Epilim Crushableand duringyourtreatment.

Taking Epilim Crushable with other medicines

Please tell your doctor or pharmacist if you are taking or have recently taken any other medicines. This includes medicines you buy without a prescription, including herbal medicines. This is because Epilim Crushable can affect the way some other medicines work. Also some medicines can affect the way Epilim Crushable works.

The following medicines can increase the chance of you getting side effects, when taken with Epilim Crushable:

• Some medicines used for pain and inflammation (salicylates) such as aspirin.
• Some other medicines used to treat fits (epilepsy).This includes medicines such as phenobarbital, primidone, phenytoin, carbamazepine, topiramate, lamotrigineand felbamate

Epilim Crushable may increase the effect of the following medicines:

• Medicines used for thinning the blood (such as warfarin)
• Zidovudine used to treat HIV infection
• Temozolomide used to treat cancer
• Medicines for depression
• Monoamine oxidase inhibitors (MAOI) such as moclobemide, selegiline, linezolid
• Medicines used to calm emotional and menta conditions such as diazepam and olanzapine

The following medicines can affect the way Epilim Crushable works:

• Some medicines used for the prevention and treatment of malaria such as mefloquine and chloroquine
• Cimetidine used for stomach ulcers
• Some medicines used for infections (antibiotics) such as imipenem, meropenem, rifampicin and erythromycin
• Colestyramine used to lower blood fat (cholesterol) levels

Pregnancy and breast-feeding Women who could become pregnant

Before you start taking Epilim Crushable, your doctor should discuss with you the possible problems when it is taken in pregnancy.

• Unplanned pregnancy is not desirable in women taking Epilim Crushable
• You should use an effective method of contraception and talk to your doctor before planning pregnancy. Epilim Crushable has no effect on how well the ora contraceptive pill works.

Well before you become pregnant it is important to discuss pregnancy and epilepsy with your doctor and, if you have one, your epilepsy specialist. This is to make sure that you and your doctor agree that you should have Epilim if you become pregnant. Women taking Epilim during pregnancy have a higher risk than other women of having a child with an abnormality. The chance of abnormalities is increased if you are also taking other medicines for epilepsy at the same time. These abnormalities include:

• Head and face deformities including cleft palate (a gap or depression in the lip)
• Deformities of the bones, including hip dislocation
• Malformations of the arms and legs
• Deformities of the tube from the bladder to the penis, where the opening is formed in a different place
• Heart and blood vessel malformations, including heart defects
• Defects of the lining of the spinal cord
• An abnormality of the spinal cord called ‘Spina bifida’

Women who take Epilim Crushable during pregnancy may be more likely to have a baby with spina bifida. Taking folic acid 5mg each day as soon as you stop contraception may lower the risk of having a baby with spina bifida.

There is also an increased risk of other birth defects. These other defects can usually be detected in the first 3 months of the pregnancy using routine antenatal screening blood tests and ultrasound scans.

Pregnant mothers who take Epilim Crushable may have babies with blood clotting problems (such as blood not clotting or not clotting very well). This may appear as bruising or bleeding which takes a long time to stop.

Some babies born to mothers who took Epilim Crushable during pregnancy may develop less quickly than normal or have autistic disorders. These children may require additiona educational support.

Talk to your doctor before you stop taking Epilim Crushable if you want to become pregnant. Do not stop taking Epilim Crushable suddenly, as it is likely that your fits will come back.

Women who are planning to get Pregnant

fyou become pregnant, think you may be pregnant or plan to become pregnant while taking Epilim Crushable, you must tell your doctor straight away.

• Your doctor will give you appropriate counselling and will suggest changes to your treatment or dose
• He or she will also want to check your progress while you are pregnant

It is very important that you discuss your treatment with your doctor well before you become pregnant.

Breast-feeding

Very little Epilim Crushable gets into the breast milk. However, talk to your doctor about whether you should breast-feed your baby.

Ask your doctor or pharmacist for advice before taking any medicine.

Driving and using machines:

You may feel sleepy when taking Epilim Crushable. If this happens to you, do not drive or use any tools or machines. Taking other medicines used to treat fits or calm emotion  and mental health problems may increase sleepiness.

How to take Epilim Crushable

Always take Epilim Crushable exactly as your doctor has told you. You should check with your doctor or pharmacist if you are not sure.

Taking this medicine

Your doctor will decide how much Epilim Crushable to give you or your child depending on your or your child’s body weight

Take this medicine by mouth

Take Epilim Crushable with or after food. This will help to stop the feelings of sickness that may happen after taking Epilim Crushable.

The tablets may be crushed if necessary

If you feel the effect of your medicine is too weak or too strong, do not change the dose yourself but ask your doctor

How to take this medicine

Take this in 2 separate doses – half in the morning and half in the evening.

How much to take

Adults (including the elderly)

The starting dose is 600mg daily. Your doctor will gradually increase this dose by 200mg every 3 days depending on your condition

The usual dose is between 1000mgand 2000mg(20-30mg per kilogram of body weight) each day

This may be increased to 2500mg each day depending on your illness

Children over 20 kilograms

The starting dose should be 400mg daily. Your doctor should increase this dose depending on your child’s illness

The usual dose is then between 20mg and 30mg for each kilogram of body weight each day

This may be further increased to 35mg for each kilogram of body weight each day depending on your child’s illness

Children under 20 kilograms

The usual dose is 20mg for each kilogram of body weight each day

Depending on the child’s condition your child’s doctor may decide to increase this dose

Patients with kidney problems

Your doctor may decide to adjust your or your child’s dose

Patients taking other medicines for ‘fits’ (epilepsy)

You oryour child may be taking other medicines for epilepsy at the same time as Epilim Crushable. If so, your doctor should gradually initiate treatment depending on you oryour child’s condition

Your doctor may increase the dose of Epilim Crushable by 5 to 10mg for each kilogram of body weight each day depending on which other medicines you are taking

If you take more Epilim Crushable than you should

If you take more Epilim Crushable than you should, tell a doctor or go to a hospital casualty department straight away. Take the medicine pack with you. This is so the doctor knows what you have taken.

The following effects may happen: feeling sick or being sick, pupils of the eye become smaller, dizziness, loss of consciousness, weak muscles and poor reflexes, breathing problems, headaches, fits (seizures), confusion, memory loss and unusual or inappropriate behaviour.

If you forget to take Epilim Crushable

If you forget to take a dose, take it as soon as you remember.

However, if it nearly time for the next dose, skip the missed dose.

Do not take a double dose to make up for a forgotten dose.

If you stop taking Epilim Crushable

Keep taking until your doctor tells you to stop. Do not stop taking Epilim Crushable just because you feel better. If you stop your fits may come back.

Tests

Make sure you or your child keep your regular appointments for a check up. They are very important as your or your child’s dose may need to be changed. Epilim Crushable can change the levels of liver enzymes shown up in blood tests. This can mean that your or your child’s liver is not working properly. If you or your child go into hospital or visit another doctor or a dentist, tell them you are taking Epilim Crushable.

Possible side effects

Like all medicines, Epilim Crushable can cause side effects, although not everybody gets them.

Tell your doctor straight away if you notice any of the following serious side effects – you may need urgent medical treatment:

• You have an allergic reaction. The signs may include: a rash, swallowing or breathing problems, swelling of your lips, face, throat or tongue. Hands, feet or genitals may also be affected. More severe allergic reactions can lead to lymph node enlargement and possible impairment of other organs.
• Liver problems and problems of the pancreas may show as a sudden illness which may happen in the first six months of treatment. This happens in a very small number of people taking Epilim Crushable. It includes feeling and being sick many times, being very tired, sleepy and weak, stomach pain including very bad upper stomach pain, jaundice (yellowing of the skin or whites of the eyes), loss of appetite, swelling (especially of the legs and feet but may include other parts of the body), worsening of your fits or a genera feeling of being unwel

Your doctor may tell you to stop taking Epilim Crushable immediately if you have these symptoms

• You have a skin rash or skin lesions with a pink/red ring and a pale centre which may be itchy, scaly or filled with fluid. The rash may appear especially on the palms or soles of your feet. These could be signs of a serious allergy to the medicine called ‘erythema multiforme’
• Blistering or bleeding of the skin around the lips, eyes, mouth, nose and genitals. Also flu-like symptoms and fever. This may be something called ‘Stevens-Johnson syndrome’
• Severe blistering rash where layers of the skin may peel off to leave large areas of raw exposed skin over the body. Also a feeling of being generally unwell, fever, chills and aching muscles. This may be something called ‘Toxic epiderma necrolysis’
• Bruising more easily and getting more infections than usual. This could be a blood problem called ‘thrombocytopenia’. It can also be due to a fall in the number of white blood cells, bone marrow depression or another condition that affects red blood cells, white blood cells and platelets (pancytopenia)
• Blood clotting problems (bleeding for longer than normal), bruising or bleeding for no reason
• Changes in mood, loss of memory, lack of concentration and deep loss of consciousness (coma)

Tell your doctor as soon as possible if you have any of the following side effects:

• Changes in behaviour including being very alert, and sometimes also aggressive, hyper-active and unusual or inappropriate behaviour. This is more likely if other medicine to treat fits such as phenobarbital and topiramate are taken at the same time or if the Epilim Crushable starting dose is high or has been suddenly increased
• Changes in the amount of ammonia in the blood. Symptoms of this condition are being sick, problems with balance and co-ordination, feeling lethargic or less alert
• Feeling shaky (tremor), sleepy or unsteady when walking or jerky muscle movements
• Feeling tired or confused with loss of consciousness sometimes accompanied by hallucinations or fits
• Blisters with the skin flaking away

Tell your doctor or pharmacist if any of the following side effects get serious or lasts longer than a few days,

or if you notice any side effects not listed in this leaflet:

• Feeling sick, stomach ache or diarrhoea, especially when starting treatment. This may be helped by taking the tablets with food or taking the Epilim EC Tablets instead
• Fainting
• Hearing loss
• Skin problems such as rashes. These happen rarely, but more often in people also taking lamotrigine
• Acne
• Hair loss which is usually temporary. When it grows back it may be more curly than before
• Hair, including body or facial hair grows more than norma in women
• Skin rash caused by narrow or blocked blood vessels (vasculitis)
• Changes in women’s periods and increased hair growth in women
• Breast enlargement in men
• Swelling of the feet and legs (oedema)
• Weight gain – as your appetite may be increased
• Kidney problems, bedwetting or increased need to pass urine

Blood tests

Epilim Crushable can change levels of liver enzymes, salts or sugars shown up on blood and urine tests.

Talk to your doctor or pharmacist if any of the side effects gets serious or lasts longer than a few days, or if you notice any side effects not listed in this leaflet.

How to store Epilim Crushable

Keep out of the reach and sight of children.

Do not take this medicine after the expiry date shown on the blister and carton after EXP. The expiry date refers to the last day of that month.

Do not remove the tablets from the foil until just before you take them. Do not cut the blister strips. Store in a dry place below 30°C.

Medicines should not be disposed of via household wastewater or household waste. Ask your pharmacist how to dispose of medicines no longer required. These measures will help protect the environment.

Further information

What Epilim Crushable contains

• Each crushable tablet contains 100mgof the active substance, sodium valproate
• The other ingredients are maize starch, kaolin light (natural), silica colloidal hydrated and magnesium stearate

What Epilim Crushable looks like and contents of the pack

Epilim Crushable tablets are white to off-white. The tablets are supplied in blister packs of 100