Encorate
Encorate is sodium valproate 200 mg immediate-release tablets from Sun Pharma — an antiepileptic / mood-stabiliser / migraine preventive. For migraine prevention: 250 mg twice daily titrated to 500-1,500 mg/day divided doses. WARNING: Pregnancy Category D — valproate causes ~10% major congenital malformation risk and 30-40% neurodevelopmental impairment risk. Women of childbearing potential require formal pregnancy-prevention programme.
✓ Medisch beoordeeld door Morgan Ellis — Apotheekonderzoeker · 8 jaar ervaring · Laatst beoordeeld: mei 2026
⚡ Quick Answer — What is Encorate?
Encorate is een 200 mg sodium valproate / valproic acid immediate-release tablet from Sun Pharma — an antiepileptic / mood-stabiliser / migraine preventive. In migraine prevention it is used at 250 mg twice daily, titrated up to 500-1,500 mg/day in divided doses as a third- or fourth-line preventive after propranolol, topiramate, and amitriptyline. Absolute contraindication in pregnancy and in women of childbearing potential without pregnancy-prevention programme — valproate causes a 10% risk of major congenital malformations (neural tube defects, craniofacial, cardiac, limb, urogenital) and a 30-40% risk of neurodevelopmental impairment (reduced IQ 7-10 points, autism spectrum). The EMA and MHRA have issued progressively stricter prescribing restrictions since 2014. Other important side effects: hepatotoxicity (idiosyncratic; serious rarely fatal), pancreatitis, thrombocytopenia, hyperammonaemia, weight gain, hair loss, tremor, and polycystic ovarian syndrome in women.
What Is Encorate?
Encorate is an oral immediate-release tablet of sodium valproate / valproic acid 200 mg from Sun Pharma, supplied in 30-180 tablet packs. Valproate is a branched short-chain fatty acid originally used as a solvent in pharmaceutical chemistry, later serendipitously discovered to have antiepileptic activity. It has been a first-line anticonvulsant for generalised and partial epilepsy since the 1970s and became the third drug with US FDA approval for migraine prophylaxis in 1996 (after propranolol and timolol).
The immediate-release formulation requires twice- or thrice-daily dosing. For patients who prefer once-daily dosing, consider Encorate Chrono (extended-release).
How Valproate Prevents Migraine
Valproate works through multiple mechanisms relevant to migraine:
- GABAergic potentiation — increases GABA synthesis and reduces its degradation, enhancing inhibitory tone in the trigeminal nucleus caudalis and cortex
- Suppression of cortical spreading depression — the pathological wave that underlies migraine aura
- Voltage-gated sodium-channel blockade — reduces neuronal hyperexcitability
- Inhibition of NMDA-glutamate transmission
In migraine-prevention trials (Jensen 1994, Mathew 1995, Klapper 1997), valproate 500-1,500 mg/day reduced monthly migraine frequency by ~50% in about half of treated patients.
Goedgekeurde Toepassingen
- Migraine prophylaxis in adults — FDA-approved 1996
- Generalised epilepsy — absence, myoclonic, tonic-clonic seizures (first-line)
- Focal epilepsy (partial seizures) — alternative to carbamazepine
- Bipolar disorder — acute mania and maintenance
- Status epilepticus (IV formulation)
Encorate Dosage for Migraine Prevention
Valproate is titrated upward over 2-4 weeks to minimise nausea:
- Week 1: 250 mg twice daily with food
- Week 2: 250 mg morning + 500 mg evening
- Week 3+: 500 mg twice daily (target; adjust 500-1,500 mg/day)
- Assess benefit at 8-12 weeks. Keep a migraine diary to quantify change.
- Therapeutic plasma levels are 50-100 μg/mL for seizure control; for migraine, levels are not routinely needed — dose by clinical response.
Monitoring:
- Baseline: LFTs (AST, ALT, bilirubin), FBC (platelet count), amylase, pregnancy test (women of childbearing potential), ammonia level (baseline)
- Month 1, 3, 6, then 6-monthly: LFTs, FBC
- Ammonia check if confusion or new cognitive symptoms
Stopzetting: taper over 2-4 weeks if stopping. In patients with co-existing epilepsy, never stop valproate without neurology input (seizure risk).
Bijwerkingen
Very common (>10%): nausea, dyspepsia, drowsiness, tremor, weight gain, hair thinning / hair loss, alopecia (usually transient; hair regrows after dose reduction or stopping).
Vaak (1-10%): ataxia, dizziness, headache, transient elevation of LFTs, thrombocytopenia (usually mild and dose-related), amenorrhoea or irregular menses, polycystic ovarian syndrome (in younger women), decreased libido, peripheral oedema.
Zeldzaam maar ernstig:
- Hepatotoxiciteit — idiosyncratic; typically in first 6 months; risk higher in children under 2, in patients with mitochondrial disorders (POLG mutations are an absolute contraindication), and in polytherapy. Presents as nausea, vomiting, fatigue, jaundice. Requires urgent LFT + discontinuation.
- Pancreatitis — rare but potentially fatal; presents with abdominal pain, nausea, vomiting, raised lipase
- Hyperammonemische encefalopathie — can occur with normal LFTs; presents as confusion, lethargy, new cognitive symptoms
- Thrombocytopenia, leukopenia — dose-related; severe forms rare
- Stevens-Johnson-syndroom / TEN — rare; stop immediately and seek urgent care
Contra-indicaties
- Pregnancy (absolute) and women of childbearing potential without pregnancy-prevention programme
- Known or suspected POLG mitochondrial disorder (and children under 2 where POLG cannot be excluded) — risk of fatal hepatotoxicity
- Severe hepatic impairment or family history of severe hepatic dysfunction
- Acute porphyria
- Pancreatitis (personal history)
- Urea cycle disorders
- Hypersensitivity to valproate
Borstvoeding: valproate passes into milk in low amounts (milk/plasma ratio ~0.02). Generally considered acceptable during breastfeeding if the drug is needed; monitor the infant for unusual lethargy or poor feeding.
Geneesmiddelinteracties
- Lamotrigine — valproate doubles lamotrigine levels; dose lamotrigine at half the usual starting dose
- Carbapenem antibiotics (meropenem, imipenem, ertapenem) — dramatically reduce valproate levels — seizure risk in epilepsy; avoid combination
- Warfarine — valproate displaces warfarin from albumin; monitor INR
- Aspirine — displaces valproate from albumin; raises free valproate concentration
- Phenytoin, carbamazepine — reduce valproate levels via CYP induction
- Other CNS depressants (benzodiazepines, alcohol, opioids) — additive sedation
Opslag
Store below 25°C in original blister. Protect from moisture. Keep out of reach of children.
Veelgestelde vragen
How long until Encorate starts preventing migraines?
Allow 8-12 weeks at target dose for full effect. Keep a migraine diary recording days per month at baseline and at week 12. A clinically meaningful response is a 50% reduction in monthly migraine days.
Is Encorate safe if I am planning pregnancy?
Nee. Valproate is one of the most teratogenic drugs in clinical use (~10% malformation risk, 30-40% neurodevelopmental impairment risk). Women of childbearing potential should be switched to a safer preventive (propranolol is preferred in pregnancy) before conception. A 3-month washout is usually recommended before trying to conceive. Valproate should not be used in women planning or able to become pregnant without a formal pregnancy-prevention programme.
Why is the immediate-release form different from Encorate Chrono?
Same molecule (sodium valproate / valproic acid), different release profile. Encorate IR is immediate-release, requires twice- or thrice-daily dosing, and has slightly higher peak plasma levels (more nausea, tremor at peak). Encorate Chrono (extended-release) allows once-daily dosing with better tolerability.
Will Encorate make me gain weight?
Yes — weight gain is one of the most common side effects (average 3-5 kg over 6-12 months, more in some). Mechanism includes increased appetite, possibly altered glucose metabolism. If weight gain is problematic, consider switching to topiramate (which causes weight loss) or propranolol (weight-neutral).
Why do I need blood tests on Encorate?
Valproate can cause hepatotoxicity, pancreatitis, thrombocytopenia, and hyperammonaemia. Baseline + periodic LFTs, full blood count, and clinical monitoring catch problems early. Therapeutic drug monitoring (levels 50-100 μg/mL) is not routinely needed for migraine prevention — dose by clinical response.
Can I drink alcohol on Encorate?
Avoid regular or heavy alcohol use. Alcohol is additive with valproate’s sedation and adds to hepatic stress. Occasional small amounts are not absolutely contraindicated but regular drinking raises the risk of hepatotoxicity. Alcohol is also a common migraine trigger; reducing intake often improves migraine independent of valproate.
Can I stop Encorate abruptly?
No — taper over 2-4 weeks. Abrupt discontinuation can trigger rebound migraine and, in patients with any seizure tendency, seizure.
Where can I buy Encorate online?
You can buy Encorate (sodium valproate 200 mg immediate-release tablet, 30-180 tablet packs) from MedsBase with discreet packaging and worldwide shipping.
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| Sterkte | 200 mg |
|---|---|
| Hoeveelheid | 30 Tabletten, 60 Tabletten, 90 Tabletten, 180 Tabletten |
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