Depakote

The active ingredient in Depakote is divalproex sodium. It is an antiepileptic drug used to help reduce the frequency and severity of seizures (focal impaired awareness seizure, absence seizure). It works by stabilizing electrical activity in the brain, preventing the abnormal and excessive firing of neurons that can trigger seizures. For those with bipolar disorder, Depakote helps regulate mood and prevents episodes of mania and depression.

Follow all directions given to you by your doctor and read all documents provided, including the full Prescribing Information, FDA-Approved Product Labeling, Instructions for Use, and Medication Guide before using Depakote. However, the following is a synopsis of the general guidelines for the use of Depakote:

• Dosage: Do not adjust the dose or frequency without consulting your doctor.
• Timing: Take the medication at the same time each day to maintain consistent blood levels.
• Swallow Whole: Swallow tablets or capsules whole; do not crush, chew, or break them.
• Food: Depakote can be taken with or without food. If stomach upset occurs, take it with food.
• If you are using the Depakote Sprinkle formulation, it is recommended that you sprinkle it on “soft food,” such as applesauce or pudding.
• Hydration: Drink plenty of fluids while taking Depakote to stay hydrated.
• Missed Dose: If you miss a dose, take it as soon as you remember unless it is close to the time for your next dose. Do not double the dose to catch up.
• Regular Monitoring: Attend all scheduled appointments for blood tests to monitor drug levels, liver function, and platelet count.
• Refills: Plan ahead for refills to avoid running out of medication. Contact your pharmacy or doctor if you need a prescription renewal.
• Discontinuation: Do not stop taking Depakote suddenly without your doctor's guidance, as it may cause serious complications.

The most common side effects of Depakote and other mild side effects include:

• Headache
• Weakness
• Dizziness
• Sleepiness
• Difficulty walking or problems with coordination
• Tremors
• Ringing in your ears
• Double or blurred vision
• Hair loss (alopecia)
• Unusual eye movement
• Swelling of your arms or legs
• Weight loss or weight gain
• Loss of appetite or increased appetite
• Nausea/vomiting
• Diarrhea
• Stomach pain
• Constipation
• Flu-like symptoms

Some individuals may experience serious side effects while using Depakote. These side effects may require immediate medical attention. If you experience any of the following, contact your healthcare provider or seek emergency medical help:

• Bleeding Problems: You may experience bruising or red or purple spots on your skin, bleeding from your mouth or nose, coughing up blood or blood clots, vomiting blood or vomit that looks like coffee grounds, blood in your stools or black stools that resemble tar, or pain and swelling in your joints.
• Low Body Temperature (Hypothermia): Treatment with Depakote may cause a drop in body temperature to below 95º F. Symptoms include feeling tired, confusion, memory loss, drowsiness, coma, or shivering. If you experience any of these, call your healthcare provider.
• Increased Ammonia Levels in Your Blood: High ammonia levels can severely impact your mental functions, reduce alertness, make you feel tired, or cause vomiting (encephalopathy). This can occur when taking Depakote alone or with topiramate. Contact your healthcare provider if you notice any of these symptoms.
• Severe Multiorgan Reactions: Depakote can cause an increased risk of life-threatening or fatal severe multiorgan reactions. Stop taking the medication and seek immediate medical help if you develop fever, skin rash, hives, sores in your mouth, blistering and peeling skin, swollen lymph nodes, swelling of the face, eyes, lips, tongue, or throat, or difficulty swallowing or breathing.
• Drowsiness or Sleepiness in the Elderly: This extreme drowsiness can lead to reduced eating or drinking. Inform your healthcare provider if you are unable to eat or drink normally. Your provider may start you on a lower dose of Depakote.
• Pancreatitis: A disease of the pancreas that is sometimes fatal.
• Serious allergic reaction: Symptoms could include hives, swelling of the tongue, lips, face, and rash.
• Liver damage
• Serious liver damage is most likely to occur in the first 6 months of treatment.
• Notify your healthcare provider if you experience nausea, vomiting, not feeling hungry, abdominal pain, yellowing of the whites of the eyes or skin, dark-colored urine, or light-colored stool.

These are not all of the possible side effects of Depakote. You should always seek medical advice from your healthcare provider for any questions or concerns about your medical condition or treatment. Read all patient information, medication guides, or drug information sheets that come with this medication. You can also report adverse effects to the Food and Drug Administration at www.fda.gov/medwatch or 1-800-FDA-1088.

Before starting Depakote, it is crucial to discuss any existing health conditions with your healthcare provider. You should be sure that your healthcare provider is aware of all your medical conditions, including if you have:

• Or have had liver problems or liver disease
• A genetic liver problem caused by Alpers-Huttenlocher syndrome, a mitochondrial disorder
• Drink alcohol
• Or have had depression, suicidal thoughts or behavior, thoughts about self-harm, or unusual changes in mood
• An allergy to any of the ingredients in Depakote
• Valproic acid
• Divalproex sodium
• Sodium valproate
• Urea cycle disorder, a genetic disorder
• A pregnancy or plan to become pregnant
• Are taking it to prevent migraine headaches and are either pregnant or may become pregnant because you are not using effective birth control (contraception)

Boxed Warning

There is evidence of liver damage, including fatalities, usually during the first 6 months of treatment.

Children who are under the age of two years are at a considerably higher risk of fatal hepatotoxicity. Patients should be monitored closely. Liver function tests should be performed before therapy and at frequent intervals thereafter.

Fetal Risk, particularly neural tube defects and other major malformations could occur.

Pancreatitis, including fatal hemorrhagic cases, could also occur.

Hepatic disease or a significant hepatic dysfunction

A known hypersensitivity to the drug

Urea cycle disorders

Depakote typically begins to work within a few days to a week, depending on the condition being treated. For seizure control, it may take several days for the full effect to be noticeable. In the case of bipolar disorder, it may take a few weeks to see significant mood stabilization.

When Depakote is taken with other prescription drugs, over-the-counter medications, vitamins, and supplements, it may change how they work or increase the frequency or severity of side effects. Make sure that you tell your healthcare professional about anything that you are taking to avoid any negative drug interactions, including:

Any medications that can affect how the liver breaks down other medicines. Examples include:

• Carbamazepine
• Phenytoin
• Phenobarbital
• Felbamate
• Primidone
• Rifampin
• Aspirin
• CNS depressants such as antihistamines, sedatives, tranquilizers, sleeping medicine, pain medicine or narcotics, barbiturates, muscle relaxants, or antianxiety medication
• Certain antidepressants (such as amitriptyline, phenelzine, and nortriptyline)
• Carbapenem antibiotics
• Estrogen-containing hormonal contraceptives
• Methotrexate
• Cannabidiol
• Warfarin
• Zidovudine
• Topiramate

The dosage of Depakote will vary depending on the specific condition being treated, the individual's age and weight, and their response to the medication. It is essential to follow your healthcare provider's instructions and take the prescribed dose as directed.

Depakote is available in different dosage forms, including delayed-release tablets and extended-release tablets. The medication is usually taken by mouth, with or without food. It is important to swallow the tablets or capsules whole and not crush or chew them, as this can affect the release of the medication.

Depakote Delayed-Release Tablets:

• 125 mg
• 250 mg
• 500 mg

Depakote ER (Extended-Release) Tablets:

• 250 mg
• 500 mg

Depakote Sprinkle Capsules (for easier administration, can be sprinkled on food):

• 125 mg

Store Depakote at room temperature, away from light and moisture. Keep out of reach of children.

Depakote (divalproex sodium) is manufactured by AbbVie.

Currently, there are lower-cost generics available for the brand name, Depakote.

Some related medications include Lamictal (lamotrigine), Tegretol (carbamazepine), Keppra (levetiracetam), and Topamax (topiramate).

To stop taking Depakote, it is important to gradually reduce the dosage under the guidance of your healthcare provider to avoid withdrawal symptoms or seizure recurrence. Sudden discontinuation can lead to serious side effects, including the return of seizures. Always consult your doctor before stopping or adjusting your medication.

If you are a pregnant woman while taking Depakote, your unborn baby is at risk of developing birth defects, such as spina bifida, and developmental delays. It is important that you are on effective birth control (contraception) while taking Depakote.

If you are a male with the ability to get someone pregnant, speak to your doctor about effective birth control measures.

Currently, there is evidence that Depakote can pass into breast milk and may harm your baby. Talk to your doctor if you are already breastfeeding or if you have any plans to breastfeed. They will know or recommend what is best for you.