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divalproex sodium

Depakote, Depakote Sprinkle, Epival†

Pregnancy Risk Category D

How supplied
valproate sodium

Syrup:
250 mg/5 ml
valproic acid

Tablets (enteric-coated):
200 mg‡, 500 mg‡
Tablets (crushable):
100 mg‡
Capsules:
250 mg
Syrup:
200 mg/5 ml‡
divalproex sodium

Capsules (delayed-release):
125 mg
Tablets (enteric-coated):
125 mg, 250 mg, 500 mg
Injection:
500-mg vial

Action
Unknown. Probably increases brain levels of gamma-aminobutyric acid, which transmits inhibitory nerve impulses in the CNS.

Indications & dosage
Simple and complex absence seizures, mixed seizure types (including absence seizures)
--
Adults and children:
initially, 15 mg/kg P.O. or I.V. daily; then increase by 5 to 10 mg/kg daily at weekly intervals up to maximum of 60 mg/kg daily.
Mania
(divalproex sodium only)--
Adults and children:
initially, 750 mg daily in divided doses. Adjust dosage based on patient's response; maximum dose is 60 mg/kg/day.
Prophylaxis for migraine headache (divalproex sodium only)--

Adults:
initially, 250 mg P.O. b.i.d. Some patients may require up to 1,000 mg/day.
Complex partial seizures--

Adults and children ages 10 and older:
10 to 15 mg/kg P.O. or I.V. daily; then increase by 5 to 10 mg/kg daily at weekly intervals, up to 60 mg/kg/day.
Elderly:
reduce initial dose.

Adverse reactions
CNS:
asthenia, sedation, emotional upset, depression, psychosis, aggressiveness, hyperactivity, behavioral deterioration, muscle weakness, tremor, ataxia, headache, dizziness, incoordination.
EENT:
nystagmus, diplopia.
GI:
nausea, vomiting, indigestion, diarrhea, abdominal cramps, constipation, increased appetite, anorexia, pancreatitis.
Hematologic:
thrombocytopenia, increased bleeding time, petechiae, bruising, eosinophilia, hemorrhage, leukopenia, bone marrow suppression.
Hepatic:
elevated liver enzyme levels, toxic hepatitis.
Metabolic:
weight gain.
Skin:
rash, alopecia, pruritus, photosensitivity, erythema multiforme.

Interactions
Drug-drug.
Aspirin, chlorpromazine, cimetidine, erythromycin, felbamate: may cause valproic acid toxicity. Use together cautiously and monitor blood levels. Monitor patient closely.
Benzodiazepines, other CNS depressants:
excessive CNS depression. Avoid concomitant use.
Lamotrigine:
increased lamotrigine levels, decreased valproate levels. Monitor levels closely.
Phenobarbital:
increased phenobarbital levels. Monitor patient closely.
Phenytoin:
increased or decreased phenytoin levels, decreased valproate levels. Monitor patient closely.
Rifampin:
may decrease valproate levels. Monitor levels.
Warfarin:
valproic acid may displace warfarin from binding sites. Monitor PT and INR.
Drug-lifestyle:
Alcohol use: excessive CNS depression. Avoid concomitant use.

Effects on diagnostic tests
Drug may produce false-positive results for urine ketones.

Contraindications
Contraindicated in patients with hypersensitivity to drug and in those with hepatic disease or significant hepatic dysfunction.

Nursing considerations

I.V. administration

Patient teaching

*Liquid contains alcohol. **May contain tartrazine.  †Canada  ‡Australia  §U.K.  OTCOver the counter
Reactions may be common, uncommon, life-threatening, or COMMON AND LIFE-THREATENING

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