Medication Information:
Divalproex sodium, valproic acid (generic) ~ Depakote, Depakote ER, Depakene (brand) ~ Valproate (common name for both forms)

Classification: Antiepileptic, mood stabilizer
Common Usage: Divalproex has an FDA-approved indication for the treatment of manic disorders associated with bipolar disorder in adults.  It is also indicated in adults for prophylaxis of migraine headaches and for the treatment of certain seizure disorders in patients 10 years of age and older.

Important Side Effects: Many patients experience mild stomach upset that can be decreased by taking valproate with food.  The divalproex salt (Depakote) causes less stomach upset than valproic acid (Depakene).  Fatigue or sedation occurs in some patients early in therapy and may continue.  If the sedation is continuing and excessive, your doctor may want to check the ammonia level in your blood.  Some hair loss is reported by patients; rarely, valproate may have to be discontinued due to excessive hair loss.  Some weight gain and mild hand tremors are frequently observed.  Slowed clotting or even some bleeding can result from decreased clotting cells (platelets) at higher doses in susceptible individuals.

Valproate has been associated with serious or fatal liver toxicity.  Use of valproate has also been associated in rare cases with pancreatitis in both children and adults.  Call your doctor if you experience malaise, weakness, lethargy, swelling (facial), abdominal pain, nausea, vomiting, and/or a decrease in appetite.  Typically, liver chemistries and blood counts are followed periodically while on this medication.

If you are female under 20 years old, your doctor may monitor you for a possible increased risk of polycystic ovary syndrome, a type of endocrine disorder than can cause obesity, acne, unwanted body hair (hirsutism), and infertility.  Valproate may cause birth defects and should be avoided if possible in women during pregnancy.  These issues should be discussed with your doctor.  Valproate should also be avoided during breastfeeding.

This is not a complete list of all known or potential adverse effects.  Notify your prescriber or pharmacist of any symptoms that have started since you began taking this medication, changing its dose, or adding or changing other medication or diet.  Take care when performing any task (for example, driving or operating machinery) that requires your attention until you have experience with this drug and are confident you can perform the task safely.

Interactions with Other Medications: Other drugs that are highly bound to albumin, a protein in your blood, are able to displace valproate and increase or decrease the effects of either the valproate or the other drug.  Such drugs include phenytoin (Dilantin), carbamazepine (Tegretol) and phenobarbital.  Combining valproate with lamotrigine (Lamictal) causes a substantial increase in the incidence of rash and should be avoided if possible.  Other drugs that may interact with valproate are aspirin, felbamate (Felbatol), rifampin (Rifadin), clonazepam (Klonopin), diazepam (Valium), ethosuximide (Zarontin), primidone (Mysoline) and warfarin (Coumadin).

This is not a complete list of all known or potential drug interactions.  To help prevent avoidable problems, always make sure your pharmacist and all prescribers know all the medications you are taking.  This includes over-the-counter drugs and any dietary or herbal supplements or medications.

Common Dosages: For mania, the recommended initial dose in adults is 750 mg daily in divided doses.  Many patients are able to tolerate a starting dose of 20 mg/kg/day with no adverse effects.  The dose should be increased as rapidly as possible to achieve the lowest therapeutic dose that produces the desired clinical effect.  The maximum recommended dosage is 60 mg/kg/day.  The extended release formulation (Depakote ER) should be taken once daily, with a starting dose of 500 mg/day for one week, increasing to 1000 mg/day thereafter.

Identification: Divalproex sodium/valproic acid is available in multiple tablet and capsule forms ranging from 125 mg to 500 mg.  Depakene is also available as a syrup.  Depakote ER comes in 250 mg and 500 mg tablets.

Storage: Store this medication at normal room temperature (59° F to 86° F) in a tightly closed, light- and moisture-resistant container.  If you have difficulty opening child-resistant containers, your pharmacist can provide a container that is easier to open.  Keep the medication out of direct sunlight and avoid storing it in a warm or humid area - such as the bathroom or kitchen - to prevent deterioration.  To prevent accidental poisoning, keep all medications out of the reach of children.  Do not take an expired medication.  Do not transfer medication from one container to another.  Carefully discard discontinued medication where children cannot find it.

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Note: These guidelines are for general information only. For more specific information, consult your physician or pharmacist.