Precautions
Depakote tablets are administered orally. The recommended initial dose is 750 mg daily in divided doses. The dose should be increased as rapidly as possible to achieve the lowest therapeutic dose which produces the desired clinical effect or the desired range of plasma concentrations.
What is the normal dosage for Depakote?
Suddenly stopping Depakote can bring on painful withdrawal symptoms, especially if you have been taking Depakote for more than two months. If you are prone to seizures, you may get them by suddenly stopping Depakote. If you think you need to decrease your dose, you and your doctor must work out a schedule to gradually decrease the dosage so ...
What if I suddenly stop taking Depakote?
What are the side effects of Depakote?
- Anger.
- Relapse of bipolar disorder.
- Depression.
- Trouble concentrating.
- Dizziness.
- Headache.
- Insomnia.
- Nausea.
What are the long term effects of Depakote?
Therapeutic efficacy is associated with a trough level concentration between 50 and 100 mmol/L (trough levels).
What is normal range for Depakote level?
See more
Is 1000 mg of Depakote a lot?
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.
How much Depakote should I take for bipolar?
Dosage formulations for acute bipolar maniaDEPAKOTE Delayed-Release TabletsDEPAKOTE ER TabletsMAXIMUM RECOMMENDED DOSE60 mg/kg/dayTHERAPEUTIC BLOOD RANGEClinical response was dosed at trough plasma concentrations between 50-125 μg/mL85 to 125 μg/mL2 more rows
What doses does Depakote come in?
Depakote tablets are supplied in three dosage strengths containing divalproex sodium equivalent to 125 mg, 250 mg, or 500 mg of valproic acid.
How much Depakote can you take a day?
The starting dose of Depakote tablets for preventing migraine episodes is 250 mg twice daily. Your doctor can increase this to a maximum daily dose of 1,000 mg. Similarly, the starting dose for Depakote ER tablets is 500 mg daily for 1 week. Then your dose may increase to a maximum of 1,000 mg.
How long does it take for Depakote to stabilize mood?
Tablets take 4 hours to reach a peak, Depakote sprinkles take just over three. Food can delay the absorption of Depakote (food has a more significant effect on the tablets compared with the sprinkles). It may take several weeks of regular dosing before an effect on mood or seizure frequency is reported.
What are the long term effects of taking Depakote?
Pancreatitis (swelling and damage of the pancreas) has also been reported, including in people who've taken Depakote for years. Liver damage and pancreatitis are long-term side effects. Depakote and Depakote ER have a boxed warning for risk of liver damage and pancreatitis.
Is Depakote a mood stabilizer or antipsychotic?
Valproate is a mood stabilizer medication that works in the brain. It is approved for the treatment of mania associated with bipolar disorder (also known as manic depression), seizures (epilepsy), and migraine headaches. Bipolar disorder involves episodes of depression and/or mania.
Is Depakote a high risk medication?
Taking Depakote has been linked to some serious and even deadly side effects. Liver damage is one of the side effects that may be fatal. This is especially true in children under 2. This risk is highest in the first months of taking the medication.
What happens if your Depakote level is too low?
Depakote levels are routinely checked with blood tests to make sure you have neither too little nor too much in your system. Too little will render it ineffective while too much may be toxic.
What are the most common side effects of Depakote?
Diarrhea, dizziness, drowsiness, hair loss, blurred/double vision, change in menstrual periods, ringing in the ears, shakiness (tremor), unsteadiness, weight changes may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.
Does Depakote help with anxiety?
Valproic Acid (Depakote) Valproic acid is an epilepsy medication that is now used for the treatment of panic attacks as well as other psychiatric problems.
Does Depakote help you sleep?
Valproic acid (Depakote) - helps somewhat with insomnia.
What is Depakote 500 mg used for?
This medication is used to treat seizure disorders, certain psychiatric conditions (manic phase of bipolar disorder), and to prevent migraine headaches. It works by restoring the balance of certain natural substances (neurotransmitters) in the brain.
What are the side effects of Depakote 500 mg?
A: Common side effects experienced with Depakote include drowsiness, nausea, abdominal pain, diarrhea, vomiting, low platelet count, tremors, tiredness, and hair loss. The side effects may be mild to moderate, but they may also be signs of a more serious condition.
What does Depakote do for bipolar?
Anticonvulsants are sometimes taken to treat the manic episodes associated with bipolar disorder. Depakote is sometimes prescribed when patients experience rapid cycling of mood episodes and works by calming the hyperactivity of the brain during mania.
Is Depakote a high risk medication?
Taking Depakote has been linked to some serious and even deadly side effects. Liver damage is one of the side effects that may be fatal. This is especially true in children under 2. This risk is highest in the first months of taking the medication.
What are the usual dosages of Depakote and Depakote ER?
Usually, your doctor will start you on a low dosage. Then they’ll adjust your dosage over time to reach the right amount for you. Your doctor will ultimately prescribe the lowest dosage that provides the desired effect.
Are Depakote and Depakote ER used long term?
Yes, Depakote and Depakote ER are typically used as long-term treatments. If you and your doctor determine that Depakote or Depakote ER is safe and effective for you, it’s likely that you’ll use it long term.
Dosage adjustments
Your doctor may adjust your dosage of Depakote or Depakote ER if you take another medication that can interact with these drugs. They may change the dosage of the other medication or of Depakote or Depakote ER. Before starting treatment, tell your doctor about any other drugs you’re taking.
Can Depakote and Depakote ER be used to treat anxiety, depression, agitation, or dementia? If so, what dosages are recommended?
The Food and Drug Administration (FDA) hasn’t approved the use of Depakote and Depakote ER for treating anxiety, depression, agitation, or dementia.
Is Depakote or Depakote ER typically prescribed in a dose of 1,500 mg?
It’s possible that your doctor may prescribe either drug at this dose.
What is a loading dose, and does Depakote or Depakote ER require one?
A loading dose usually refers to a larger starting dose that decreases over time. Loading doses are used when a high dose of medication is needed to improve symptoms of a condition quickly.
Do Depakote or Depakote ER come in a liquid form to be given by IV?
Depakote and Depakote ER only come as medications that you take by mouth.
Are Depakote or Depakote ER taken for anxiety or depression? If so, what are the drugs’ dosages?
The Food and Drug Administration (FDA) hasn’t approved the use of Depakote or Depakote ER for anxiety or depression. However, doctors may prescribe these drugs off-label for these conditions. Off-label use is prescribing a medication for a different purpose than what it’s approved for by the FDA.
Are Depakote or Depakote ER prescribed in a dose of 1,500 milligrams (mg)?
Yes, your doctor can prescribe Depakote ER in a dose of 1,500 mg. However, keep in mind that your dose of Depakote or Depakote ER will depend on certain factors, such as your body weight.
Are Depakote or Depakote ER available as a liquid? Can either drug be given by IV?
No, Depakote and Depakote ER aren’t given by IV injection. They don’t come in liquid form. The drugs come as tablets or sprinkle capsules.
What to know before taking divalproex?
PRECAUTIONS: See also Warning section.Before taking divalproex sodium, tell your doctor or pharmacist if you are allergic to it; or to valproic acid or valproate sodium; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: liver disease, pancreatitis, certain metabolic disorders (such as urea cycle disorders, Alpers-Huttenlocher syndrome), alcohol abuse, bleeding problems, brain disease (dementia), kidney disease, dehydration, poor nutrition.To lower the chance of getting cut, bruised, or injured, use caution with sharp objects like razors and nail cutters, and avoid activities such as contact sports.Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).This drug may make you dizzy or drowsy or blur your vision. Alcohol or marijuana (cannabis) can make you more dizzy or drowsy. Do not drive, use machinery, or do anything that needs alertness or clear vision until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).Children younger than 6 years may be at greater risk for liver problems and pancreatitis.Older adults may be more sensitive to the side effects of this drug, especially drowsiness, dizziness, unsteadiness, or tremor. Drowsiness, dizziness, unsteadiness can increase the risk of falling.This medication is not recommended for use during pregnancy. It may harm an unborn baby. See also Warning section.This medication passes into breast milk. While there have been no reports of harm to nursing infants, consult your doctor before breast-feeding.
How is valproate metabolized in the liver?
Valproate metabolized in liver by glucuronidation (30-50%) and mitochondrial beta-oxidation (40%) <15-20% is eliminated by other oxidative mechanisms
What are the signs of valproate in a breastfed infant?
Monitor breastfed infant for signs of liver damage including jaundice and unusual bruising or bleeding; there have been reports of hepatic failure and clotting abnormalities in offspring of women who used valproate during pregnancy
How to take divalproex?
If you have any questions, ask your doctor or pharmacist.Take this medication by mouth once daily or as directed by your doctor . You may take it with food if stomach upset occurs. Do not crush or chew extended-release tablets. Doing so can release all of the drug at once, increasing the risk of side effects. Also, do not split the tablets unless they have a score line and your doctor or pharmacist tells you to do so. Swallow the whole or split tablet without crushing or chewing.The dosage is based on your age, weight, medical condition, response to treatment, and other medications you may be taking. Be sure to tell your doctor and pharmacist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products). Use this medication regularly in order to get the most benefit from it. Remember to use it at the same time each day to keep the amount of medication in your blood constant.If this medication is used for seizures, do not stop taking it without consulting your doctor. Your condition may become worse if the drug is suddenly stopped. Your dose may need to be gradually decreased.Divalproex sodium does not relieve acute migraine headaches. Take other medications as directed by your doctor for acute attacks.Inform your doctor if your condition does not improve.
Where is divalproex metabolized?
Divalproex sodium dissociates to the valproate ion in the GI tract. Valproate metabolized in liver by glucuronidation (30-50%) and mitochondrial beta-oxidation (40%) <15-20% is eliminated by other oxidative mechanisms.
What is the purpose of simple and complex absence seizures?
Simple and complex absence seizures: Also indicated for use as sole and adjunctive therapy in the treatment of simple and complex absence seizures, and adjunctively in patients with multiple seizure types that include absence seizures.
What is complex partial seizures?
Complex partial seizures: Indicated as monotherapy and adjunctive therapy for complex partial seiz ures that occur either in isolation or in association with other types of seizures
Dosages Used in Treating Epilepsy
In cases of complex or partial absence seizures, the recommended starting dosage of Depakote is 6.8mg per lb of body weight per day.
Recommended Dosage for Bipolar Disorder and Migraines
Patients suffering from bipolar disorder will normally receive a dosage of 750mg per day. This is usually divided into at least two smaller doses to be taken throughout the day. To help manage the symptoms of bipolar disorder, the doctor will usually increase the dose rapidly from here on.
Will I need to use this drug long term?
Depakote and Depakote ER are meant to be used as long-term treatments for certain types of seizures and to help prevent migraine. If you take either drug for one of these conditions and your doctor determines that it’s safe and effective for you, you’ll likely take the medication long term.
Is Depakote or Depakote ER used for anxiety, depression, or schizophrenia? If so, what’s the dosage?
Depakote and Depakote ER are not specifically approved to treat anxiety, depression, or schizophrenia. So there aren’t recommended dosages for these conditions. However, they might be prescribed off-label * for these conditions if other medications haven’t worked well enough.
Is Depakote or Depakote ER a mood stabilizer or antipsychotic?
Depakote and Depakote ER are not antipsychotics. They’re sometimes called mood stabilizers when used to treat bipolar disorder. Depakote and Depakote ER actually belong to a group of drugs called anticonvulsants (also called antiepileptics or seizure medications).
Does Depakote or Depakote ER come as a liquid? Is either drug given by IV?
No, Depakote and Depakote ER are not available as a liquid, and they are not given by IV injection.
Are there side effects from stopping Depakote or Depakote ER? Can you stop these drugs ‘cold turkey’?
Stopping Depakote or Depakote ER treatment shouldn’t cause side effects. These medications don’t cause dependence, and withdrawal symptoms haven’t been reported* in people who stop taking them “cold turkey.” Withdrawal symptoms are side effects that you may have if you stop taking a drug your body is dependent on. Stopping cold turkey is when you suddenly stop taking a drug.
Can Depakote and Depakote ER be crushed, split, or chewed?
Depakote delayed-release tablets and Depakote ER tablets should not be crushed, split, or chewed. Doing so will damage their delayed-release or extended-release action. These tablets should be swallowed whole. This is easier if you take them with water.
What do Depakote and Depakote ER do?
Depakote and Depakote ER increase the level of a chemical called gamma-aminobutyric acid (GABA) in your brain. GABA has a calming effect on the nerve cells in your brain.
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.
What Is Depakote?
Depakote (divalproex sodium) is a prescription anti-epileptic drug (AED) used to prevent seizures and migraines and treat manic episodes in bipolar disorder in children and adults. Taken by mouth, Depakote comes as a standard tablet, an extended-release tablet, a delayed-release tablet, and a sprinkle capsule.
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.
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.
How is valproate metabolized?
Valproate is metabolized almost entirely by the liver. In adult patients on monotherapy, 30-50% of an administered dose appears in urine as a glucuronide conjugate. Mitochondrial β-oxidation is the other major metabolic pathway, typically accounting for over 40% of the dose. Usually, less than 15-20% of the dose is eliminated by other oxidative mechanisms. Less than 3% of an administered dose is excreted unchanged in urine.
What is the drug used for manic episodes?
Depakote (divalproex sodium) is a valproate and is indicated for the treatment of the manic episodes associated with bipolar disorder . A manic episode is a distinct period of abnormally and persistently elevated, expansive, or irritable mood. Typical symptoms of mania include pressure of speech, motor hyperactivity, reduced need for sleep, flight of ideas, grandiosity, poor judgment, aggressiveness, and possible hostility.
Why should valproate be reduced?
Due to a decrease in unbound clearance of valproate and possibly a greater sensitivity to somnolence in the elderly , the starting dose should be reduced in these patients. Dosage should be increased more slowly and with regular monitoring for fluid and nutritional intake, dehydration, somnolence, and other adverse reactions. Dose reductions or discontinuation of valproate should be considered in patients with decreased food or fluid intake and in patients with excessive somnolence. The ultimate therapeutic dose should be achieved on the basis of both tolerability and clinical response [see Warnings and Precautions (5.13)].
Can adverse reaction rates be directly compared to rates in clinical studies of another drug?
Because clinical studies are conducted under widely varying conditions, adverse reaction rates observed in the clinical studies of a drug cannot be directly compared to rates in the clinical studies of another drug and may not reflect the rates observed in practice.
Does Valproate stimulate replication?
There are in vitro studies that suggest valproate stimulates the replication of the HIV and CMV viruses under certain experimental conditions. The clinical consequence, if any, is not known. Additionally, the relevance of these in vitro findings is uncertain for patients receiving maximally suppressive antiretroviral therapy. Nevertheless, these data should be borne in mind when interpreting the results from regular monitoring of the viral load in HIV infected patients receiving valproate or when following CMV infected patients clinically.
Does carbapenem reduce valproate?
Carbapenem antibiotics (for example, ertapenem, imipenem, meropenem; this is not a complete list) may reduce serum valproate concentrations to subtherapeutic levels, resulting in loss of seizure control. Serum valproate concentrations should be monitored frequently after initiating carbapenem therapy. Alternative antibacterial or anticonvulsant therapy should be considered if serum valproate concentrations drop significantly or seizure control deteriorates [see Drug Interactions (7.1)].
Does Valproate cause hyperammonemia?
Hyperammonemia has been reported in association with valproate therapy and may be present despite normal liver function tests. In patients who develop unexplained lethargy and vomiting or changes in mental status, hyperammonemic encephalopathy should be considered and an ammonia level should be measured. Hyperammonemia should also be considered in patients who present with hypothermia [see Warnings and Precautions (5.10)]. If ammonia is increased, valproate therapy should be discontinued. Appropriate interventions for treatment of hyperammonemia should be initiated, and such patients should undergo investigation for underlying urea cycle disorders [see Contraindications (4) and Warnings and Precautions
Management
- There is no body of evidence available from controlled trials to guide a clinician in the longer term management of a patient who improves during Depakote treatment of an acute manic episode. While it is generally agreed that pharmacological treatment beyond an acute response in mania i…
Treatment
- Monotherapy (Initial Therapy) Depakote has not been systematically studied as initial therapy. Patients should initiate therapy at 10 to 15 mg/kg/day. The dosage should be increased by 5 to 10 mg/kg/week to achieve optimal clinical response. Ordinarily, optimal clinical response is achieved at daily doses below 60 mg/kg/day. If satisfactory clinical response has not been achieved, plas…
Side effects
- The probability of thrombocytopenia increases significantly at total trough valproate plasma concentrations above 110 mcg/mL in females and 135 mcg/mL in males. The benefit of improved seizure control with higher doses should be weighed against the possibility of a greater incidence of adverse reactions. The frequency of adverse effects (particularly elevated liver enzymes and t…
Interactions
- As the Depakote dosage is titrated upward, blood concentrations of phenobarbital and/or phenytoin may be affected [see Drug Interactions (7.2)].
Contraindications
- Antiepilepsy drugs should not be abruptly discontinued in patients in whom the drug is administered to prevent major seizures because of the strong possibility of precipitating status epilepticus with attendant hypoxia and threat to life.