When taken during pregnancy, Depakote can cause birth malformations in the fetus.
Pancreatitis, including fatal cases, has been reported in people taking this medication.
Depakote works by increasing the amount of gamma-aminobutyric acid (GABA) in the brain. GABA is an amino acid and neurotransmitter that inhibits activity in the brain. A neurotransmitter is a chemical that is responsible for carrying information from one cell to another.
What Is Depakote Used For?
The Food and Drug Administration (FDA) approved Depakote for several uses. It is among the most prescribed AEDs for children who have epilepsy. Depakote is used as monotherapy (the only AED) and as adjunctive therapy (with one or more other AEDs).
Brand Name(s): Depakote, Depakote DR, Depakote ER, Depakote Sprinkles
Administration Route(s): Oral
Drug Availability: Prescription
Therapeutic Classification: Anticonvulsant, antimigraine
Available Generically: Yes
Controlled Substance: N/A
Active Ingredient: Divalproex sodium
Dosage Form(s): Tablet, capsule
The FDA approved Depakote for the following uses:
Manic episodes of bipolar disorder Prevention of migraines Alone or with other AEDs to prevent complex partial seizures (seizures that start in one area of the brain and cause impaired consciousness) in adults and children aged 10 years and older Alone or with other AEDs to prevent simple and complex absence seizures (seizures that affect the whole brain) Add-on therapy for the treatment of seizure disorders with multiple seizure types that include absence seizures
The sprinkle formulation is only approved for seizure indications, not for migraine prevention or for mania.
How to Take Depakote
Your healthcare provider will prescribe Depakote to take either once or twice a day. Take Depakote tablets whole; do not chew or crush them.
Depakote sprinkle capsules can be swallowed whole or opened. If you open the capsule, sprinkle its contents on soft food to consume.
Storage
This medication should be stored in its original container and away from children and pets.
Each formulation has its storage instructions:
Regular and delayed-release: Store tablets at a temperature below 86 F. Extended-release: Store tablets at 77 F; it is OK to store between 59 F to 86 F for a short period. Sprinkles: Store capsules below 77 F.
Off-Label Uses
Sometimes Depakote is prescribed for off-label uses. In these cases, a doctor might prescribe Depakote for conditions not specified on the prescribing label if they deem it medically appropriate.
Depakote is most commonly prescribed off-label for:
Schizophrenia Schizoaffective disorder Preventing pain symptoms of peripheral neuropathy
The instructions and dosing of Depakote can vary when it is prescribed for off-label uses.
What Are the Side Effects of Depakote?
This is not a complete list of side effects and others may occur. A medical professional can advise you on side effects. If you experience other effects, contact your pharmacist or a medical professional. You may report side effects to the FDA at www.fda.gov/medwatch or 1-800-FDA-1088.
Depakote is often well tolerated. However, it can cause a variety of side effects that range from mild to severe. Sometimes Depakote can also cause health complications that are harmful to the body.
Common Side Effects
The most common side effects of Depakote are:
Abdominal pain Accidental injury Alopecia (hair loss) Blurred vision, double vision, nystagmus (jerking eyes) Amnesia (memory loss) Anorexia (loss of appetite), nausea, vomiting, weight loss Weakness, lack of energy, excessive sleepiness Dizziness, diminished balance and coordination Back pain Congestion, sore throat, bronchitis, flu, infections Constipation, diarrhea Depression, emotional instability Indigestion Shortness of breath Bruising Fever Headaches Insomnia (trouble sleeping) Nervousness, tremors Peripheral edema (swelling of the extremities) Rash Confusion Tinnitus (ringing in the ears) Weight gain, increased appetite
The common side effects are usually mild and tolerable, but they can be severe and distressing for some people. It is difficult to know how Depakote may affect you. Talk to your healthcare provider about your side effects. They may be able to help you manage some of your side effects.
Severe Side Effects
Depakote can cause serious, sometimes fatal side effects. It’s important to be aware of these side effects and to talk to your healthcare provider if you start to experience any of them.
Serious side effects of Depakote include:
Liver damage: Harm to the liver can be life-threatening, especially during the first six months of treatment or for children under 2 years of age. Birth deformities: When taken during pregnancy, the baby can develop brain, spine, or other significant malformations. Pancreatitis: Inflammation of the pancreas can be life-threatening.
Long-Term Side Effects
The side effects of Depakote can have long-term implications:
Liver failure and pancreatitis due to Depakote can cause lasting organ damage. Fetal risks may cause lifelong health issues for the baby. Depakote is used with extreme caution during pregnancy and only if necessary.
Dosage: How Much Depakote Should I Take?
Modifications
Older adults should start with a reduced dose, with slower dose increases and additional fluid and nutritional intake monitoring. Additionally, if you experience stomach upset, you might benefit from slowly building up your initial dose and/or taking Depakote with food.
If you experience a serious side effect, you or your provider may send a report to the Food and Drug Administration’s (FDA) MedWatch Adverse Event Reporting Program or by phone (800-332-1088).
The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.
For oral dosage forms (delayed-release tablets or tablets): For mania: Adults—At first, 750 milligrams (mg) once a day, usually divided in smaller doses. Your doctor may increase your dose as needed. However, the dose is usually not more than 60 mg per kilogram (kg) of body weight per day. Children—Use and dose must be determined by your doctor. For migraine: Adults—At first, 250 milligrams (mg) 2 times a day. Your doctor may increase your dose as needed. However, the dose is usually not more than 1000 mg per day. Children—Use and dose must be determined by your doctor. For seizures: Adults and children 10 years of age or older—Dose is based on body weight and must be determined by your doctor. At first, the usual dose is 10 to 15 milligrams (mg) per kilogram (kg) of body weight per day. Your doctor may increase your dose gradually every week by 5 to 10 mg per kg of body weight if needed. However, the dose is usually not more than 60 mg per kg of body weight per day. If the total dose a day is greater than 250 mg, it is usually divided into smaller doses and taken 2 or more times during the day. Children younger than 10 years of age—Use and dose must be determined by your doctor. For oral dosage form (extended-release tablets): For mania: Adults—Dose is based on body weight and must be determined by your doctor. At first, the usual dose is 25 milligrams (mg) per kilogram (kg) of body weight once a day. Your doctor may increase your dose as needed. However, the dose is usually not more than 60 mg per kg of body weight per day. Children—Use and dose must be determined by your doctor. For migraine: Adults—At first, 500 milligrams (mg) once a day for 1 week. Your doctor may increase your dose as needed. However, the dose is usually not more than 1000 mg per day. Children—Use and dose must be determined by your doctor. For seizures: Adults and children 10 years of age or older—Dose is based on body weight and must be determined by your doctor. At first, the usual dose is 10 to 15 milligrams (mg) per kilogram (kg) of body weight per day. Your doctor may increase your dose gradually every week by 5 to 10 mg per kg of body weight if needed. However, the dose is usually not more than 60 mg per kg of body weight per day. Children younger than 10 years of age—Use and dose must be determined by your doctor. For oral dosage form (sprinkle capsules): For seizures: Adults and children 10 years of age or older—Dose is based on body weight and must be determined by your doctor. At first, the usual dose is 10 to 15 milligrams (mg) per kilogram (kg) of body weight a day. Your doctor may increase your dose gradually every week by 5 to 10 mg per kg of body weight if needed. However, the dose is usually not more than 60 mg per kg of body weight per day. If the total dose a day is greater than 250 mg, it is usually divided into smaller doses and taken 2 or more times during the day. Children younger than 10 years of age—Use and dose must be determined by your doctor.
Missed Dose
If you miss a dose, take the next one as soon as possible. If it is too close to your next scheduled dose, skip the missed dose. Do not double up on doses.
Overdose: What Happens If I Take Too Much Depakote?
If you accidentally or deliberately consume high amounts of Depakote, you can experience severe and life-threatening effects.
Effects of Depakote overdose include:
Diminished alertness Heart block Deep coma Hypernatremia (high blood sodium levels)
Overdose symptoms, such as hypernatremia and heart block, can be medically managed. Naloxone may reverse some of the effects, but it may bring on a seizure, so it is used with extreme caution in epilepsy. Additionally, hemodialysis may help remove the drug from the body.
Precautions
What Are Reasons I Shouldn’t Take Depakote?
You should not take Depakote if you have:
If someone collapses or isn’t breathing after taking Depakote, call 911 immediately.
Using this medicine while you are pregnant (especially during the first 3 months of pregnancy) can harm your unborn baby and cause serious unwanted effects (eg, brain or facial problems, heart or blood vessel problems, arm or leg problems, or intelligence or mental problems). Use an effective form of birth control to keep from getting pregnant. If you think you have become pregnant while using the medicine, tell your doctor right away.
It is very important to take folic acid before getting pregnant and during early pregnancy to lower chances of harmful side effects to your unborn baby. Ask your doctor or pharmacist for help if you are not sure how to choose a folic acid product.
Liver problems may occur while you are using this medicine, and some may be serious. Check with your doctor right away if you are having more than one of these symptoms: abdominal or stomach pain or tenderness, clay-colored stools, dark urine, decreased appetite, fever, headache, itching, loss of appetite, nausea and vomiting, skin rash, swelling of the feet or lower legs, unusual tiredness or weakness, or yellow eyes or skin.
Pancreatitis may occur while you are using this medicine. Tell your doctor right away if you have sudden and severe stomach pain, chills, constipation, nausea, vomiting, fever, or lightheadedness.
Check with your doctor right away if you are having unusual drowsiness, dullness, tiredness, weakness or feelings of sluggishness, changes in mental status, low body temperature, or vomiting. These may be symptoms of a serious condition called hyperammonemic encephalopathy.
Divalproex sodium may cause some people to become dizzy, lightheaded, drowsy, or less alert than they are normally. Do not drive or do anything else that could be dangerous until you know how this medicine affects you.
Do not stop using this medicine without first checking with your doctor. Your doctor may want you to gradually reduce the amount you are using before stopping completely. This may help prevent worsening of seizures and reduce the possibility of withdrawal symptoms.
Before you have any medical tests, tell the medical doctor in charge that you are using this medicine. The results of some tests may be affected by this medicine.
Divalproex sodium may cause serious allergic reactions affecting multiple body organs (eg, liver or kidney). Check with your doctor right away if you have the following symptoms: a fever, dark urine, headache, rash, stomach pain, swollen lymph glands in the neck, armpit, or groin, unusual tiredness, or yellow eyes or skin.
Divalproex sodium may cause some people to be agitated, irritable, or display other abnormal behaviors. It may also cause some people to have suicidal thoughts and tendencies or to become more depressed. If you notice any of these side effects, tell your doctor right away.
This medicine will add to the effects of alcohol and other CNS depressants (medicines that cause drowsiness). Some examples of CNS depressants are antihistamines or medicine for hay fever, other allergies, or colds, sedatives, tranquilizers, or sleeping medicine, prescription pain medicine or narcotics, medicine for seizures (eg, barbiturates), muscle relaxants, or anesthetics, including some dental anesthetics. Check with your doctor before taking any of the above while you are using this medicine.
If you plan to have children, talk with your doctor before using this medicine. Some men receiving this medicine have become infertile (unable to have children).
Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.
Liver disease or dysfunction A POLG-related mitochondrial disorder Known allergy to the drug Urea cycle disorders (genetic disorders that can cause serious neurological symptoms)
You should also not take Depakote if you are pregnant or planning to become pregnant.
What Other Medications Interact With Depakote?
Many medications interact with Depakote. However, there are no absolute contraindicated medications that can’t be taken with Depakote. If needed, your healthcare provider will make dosing adjustments when you are taking Depakote along with a drug that it interacts with.
Interactions include:
Phenytoin, carbamazepine, phenobarbital, primidone, rifampin: Can reduce Depakote levels Felbamate: Can increase Depakote levels Topiramate: Used together, can cause elevated ammonia levels and encephalopathy
Some other medications that can interact with Depakote include:
Aspirin Carbapenem antibiotics Estrogen-containing hormonal contraceptives Diazepam Ethosuximide Lamotrigine Amitriptyline/nortriptyline Rufinamide Propofol Warfarin Zidovudine
What Medications Are Similar?
Depakote is among the more versatile AEDs because it can be prescribed for several types of seizures. However, there are other available seizure therapies as well.
Other medications used to treat seizures that are similar to Depakote include:
Depacon (valproate sodium) Lamictal (lamotrigine) Tegretol (carbamazepine)
Depacon is used to treat complex partial seizures and absence seizures. It is available in an intravenous (IV) formulation for patients who are unable to manage oral medications.
Lamictal is indicated for the add-on treatment of epilepsy in children aged 2 and older, treatment of epilepsy in people 16 years and older, and treatment of bipolar disorder in adults.
Tegretol is also used for several seizure types, specifically focal (partial) seizures and generalized tonic-clonic seizures.
How Can I Stay Healthy While Taking Depakote?
Depakote can control your medical condition, substantially improving your quality of life. However, it can cause side effects that could be intolerable or can cause serious harm to your health. If you are taking Depakote, you must take care of the condition you are being treated for and try to avoid problems from taking Depakote.
Stay healthy while taking Depakote by:
Taking Depakote as directed Avoiding seizure triggers, such as sleep deprivation, alcohol, drugs, and flashing lights Maintaining psychotherapy if you have bipolar disorder Avoiding stress if possible
Tell your healthcare provider if you:
Start taking any new medications, supplements, or herbal treatmentsBegin to experience side effectsThink Depakote isn’t working for you
