An increased incidence of osteopenia, osteomalacia, hypocalcemia and elevated alkaline phosphatase activity has been associated with long term anticonvulsant therapy . Skeletal toxicity may result from increased catabolism of vitamin D and its metabolites by anticonvulsant enzyme induction. Patients at highest risk for hypocalcemia and skeletal changes are those who, because of severe epilepsy and mental retardation, require institutionalization. Studies have shown that this group of patients taking concurrent phenytoin and phenobarbital had lower levels of 25-hydroxycholecalciferal and calcium, higher alkaline phosphatase levels and lower bone masses than patients on monotherapy . It is recommended that institutionalized patients receive vitamin D supplementation (4000 to 6000 U vitamin D2 daily for four months, followed by a maintenance regimen of 1000 U vitamin D2 daily).

Valproic acid is rarely associated with secondary amenorrhea . However, polycystic ovaries and/or hyperandro-genism is more common in women receiving valproate. In one study, 43% of women receiving valproate had polycystic ovaries and 38% had elevated serum testosterone concentrations without polycystic ovaries. Valproate-induced weight gain is associated with a metabolic syndrome with many features of insulin resistance. You can be sure your pharmacy offers buy Tavist online delivering fast internationally.

An increased incidence of Dupuytren’s contracture (shortening, thickening and fibrosis of the palmar fascia, producing a flexion deformity of a finger) is related to phenobarbital and primidone ingestion. Resolution of symptoms may occur when the drug is withdrawn. Valproic acid’s effect on mitochondrial function induces hyperammonemia, decreased carnitine levels and hyperglycinemia . Although most patients who develop hyperammonemia are asymptomatic, some patients may experience sedation.