Overview

Depakote is the brand name for Divalproex sodium oral tablet (delayed-release), and Depakote ER is the brand name for the extended-release. This drug may be taken with other medicines, and can also be a part of combination therapy.

Why it’s used

This medication, whether taken on its own or with other drugs, is intended to:

• Treat seizures such as:
• Simple and complex absence seizures
• Multiple types of seizure including absence seizures
• Complex partial seizures that either happens on their own or are linked with some other kinds of seizures
• Treat the manic episode of a bipolar disorder
• This phase is when the mood is high or extremely strong, and can also include irritated mood
• Prevent migraines
• Though there is no proof that it affects if the person already has one

How it works

Divalproex sodium oral tablet is part of a class of drugs called anti-epileptics. These type of drugs are formulated to prevent migraines, treat the manic phase in a bipolar disorder, and to treat seizures. Anti- epileptics function by increasing brain concentrations of GABA, a type of chemical that reduces excitability in the nervous system.

Side Effects

Those taking this medication may experience some common or severe side effects, and it may also cause dizziness and drowsiness. It is not advised to drive or use machinery as a safety precaution until you are aware of how your body reacts with this drug.

Some of its common side effects may include:

• Hair loss
• Problem with coordination or walking
• Nausea
• Sleepiness
• Vomiting
• Headache
• Dizziness
• Stomach pain
• Weakness
• Tremor
• Weight loss
• Weight gain
• Diarrhea
• Change in appetite

Its serious side effects are:

• Bleeding, and the symptoms for this are:
• Bleeding from the nose or mouth
• Red or purple spots on the skin
• Getting bruised easily than usual
• High ammonia levels in the blood, with symptoms such as:
• Confusion
• Feeling tired
• Vomiting
• Hypothermia or low body temperature, with symptoms being:
• Slurred speech
• Drop in the body temperature (less than 35°C)
• Weak pulse
• Tiredness
• Coma
• Slow, shallow breathing
• Confusion
• Hypersensitivity or allergic reactions, symptoms for this include:
• Pain and swelling in the liver, muscles, heart or kidneys
• Skin rash
• Fever
• Swollen lymph nodes
• Hives
• Difficulty in breathing or swallowing
• Sores in the mouth
• Swelling of the face, throat, lips, tongue, or eyes
• For older people or seniors, sleepiness or drowsiness
• Liver damage, with symptoms including:
• Vomiting
• Weakness
• Facial swelling
• Lack of appetite
• Pancreatitis, with symptoms being:
• Severe abdominal pain
• Vomiting
• Loss of appetite
• Nausea

If the experience of any of the symptoms like nausea is not severe, they are expected to go away after a few days. However, if symptoms become more serious, see your health care provider right away. If you are experiencing any of the serious side effects, call 911 or go to the local emergency services as soon as possible.  

Indication and Dosage

The following forms and dosages that are mentioned here are just based on the average use according to the kind of treatment it is used for. But the dosage may vary depending on the following factors:

• Age
• Condition treated
• Severity of condition
• Presence of other medical conditions
• The reaction of the body to the medicine

Drug forms and strengths

Generic Divalproex sodium

• Form: oral tablet (delayed-releasee)
• Strengths: 125mg, 250mg, 500mg
• Form: oral tablet (extended-release)
• Strengths: 250mg, 500mg

Brand:

Depakote

• Form: oral tablet (delayed-releasee)
• Strength: 125mg, 250mg, 500mg

Depakote ER

• Form: oral tablet (extended-release)
• Strengths: 250mg, 500mg

Dosage for seizures

Adult dosage for 18 to 64 years old

• Complex partial seizures:

-typical initial dosage: For extended-release tablets, strength should be 10 to 15mg/kg and should be taken only once a day. But for delayed-releasee tablets, the dosage should be 2 to 3 times a day.

• Typical dosage increases: dosage is increased at one-week intervals by 5 to 10mg/kg a day as per doctor’s advice.
• Maximum dosage: 60mg/kg a day

• Absence seizures:
• Typical initial dosage: For extended-release tablets, a 15mg/kg dosage should be taken once a day, and for delayed-releasee tablets, medicine should be taken 2 to 3 times a day.
• Typical dosage increases: dosage increase is done at one-week intervals by 5 to 10mg/kg a day as per doctor’s instruction.
• Maximum dosage: 60mg/kg a day

Child dosage for ages 10 to 17 years old

• Complex partial seizures:
• Typical initial dosage: For extended-release tablets, the child should take a 10 to 15mg/kg dosage once a day, and for delayed-releasee tablets, the dosage recommended is 2 to 3 times per day.
• Typical dosage increases: dosage may be increased at the one-week interval by 5 to 10mg/kg a day as per doctor’s recommendation
• Maximum dosage: 60mg/kg a day

• Absence seizures:
• Typical initial dosage: Extended-releasee tablets with 15mg/kg dosage should be taken by mouth once a day. But for delayed-releasee tablets, the dosage should be taken 2 to 3 times a day
• Typical dosage increases: the doctor may increase the dosage by 5 to 10mg/kg at a one-week interval
• Maximum dosage: 60mg/kg a day

Child dosage for 0 to 9 years old

This medication should not be used for children under ten years of age as studies have not been made for them.

Senior dosage for 65 years and up

Since the body may process this drug more slowly for this age, the senior may experience a higher sedative effect. Because of this, a lower dosage will likely be given and may increase it gradually to prevent the drug from building- up too much in the body as too much of it can cause harmful side effects.  

Dosage for older people will most likely be kept to the minimum effective dosage and something that their body can tolerate without experiencing any side effects.

Dosage for bipolar disorder mania

Adult dosage for ages 18 to 64 years old

• Typical initial dosage: Delayed-releasee tablets with 375mg dosage should be taken by mouth twice a day or 250mg 3 times a day. As for extended-release tablets, the dosage is 25mg/kg and should be taken once a day.
• Typical dosage increases: dosage will be likely increased as soon as possible until the medicine has reached its effectivity or until the desired blood level is achieved.
• Maximum dosage: 60mg/kg a day

Child dosage for 0 to 17 years old

This medicine is not intended to treat mania for those who are younger than 18 years old, and it also did not show effectiveness in children with mania.

Senior dosage for 65 years and up

Dosage for older people will be kept at the lowest to avoid experiencing any side effects.

Dosage warning

Divalproex is not proven effective for the treatment of mania that is longer than three weeks.

Dosage for migraine prevention

Adult dosage for 18 to 64 years old

• Typical initial dosage: delayed-releasee tablets with 250mg dosage should be taken twice a day, and extended-release tablets with 500mg dosage should be taken once a day
• Typical dosage increases: the dosage will be increased by the doctor only if necessary
• Maximum dosage: 1,000mg a day

Child dosage for 0-17 years old:

This drug is not for children under 18 years old.

Senior dosage (65 years and up):

The lowest effective dosage will be given.

Special dosage considerations

For those with liver disease: Divalproex sodium should not be used by people with severe liver problems as this drug will not be absorbed by the body.

Drug Interaction

Divalproex may cause interactions with the following drugs:

• Anti-seizure drugs
• Tuberculosis drug
• HIV drug
• Anesthetic drug
• Aspirin
• Mood disorder drug
• Carbapenem antibiotics
• Blood thinner drug
• Hormonal birth control with estrogen
• Migraine prevention drug

Warnings and Precautions

This medication should only be taken as prescribed to avoid harmful side effects such as:

• Pancreatitis
• Hepatotoxicity
• Teratogenicity

Overdose and Contraindications

Contraindications

Divalproex is not recommended for those with hepatic disease. While extended-release tablets are not advisable to be used as a treatment for patients with mitochondrial disorders, those with hypersensitivity to the drug, those with urea cycle disorder, and should not be used to prevent migraine in pregnant women.

Overdosage

Overuse of this drug may cause severe side effects such as deep coma, somnolence, heart block, and hypernatremia.

Clinical Pharmacology

Divalproex sodium disintegrates to the valproate ion in the gastrointestinal tract, but the process by which valproate produces therapeutic effects is not yet defined. Its effect in epilepsy is said to be associated with the increased brain concentrations of GABA.

Medication Guide

It is very important to read the medication guide before starting the treatment for Divalproex sodium extended-release tablets to avoid experiencing serious side effects.  

It is also important to know that stopping this medication abruptly may cause harmful effects. Consult your doctor first if you have plans to stop the medication.

This medicine is not for pregnant women and those with serious liver damage. It may also cause suicidal thoughts or actions; that’s why it should only be taken as prescribed.