Brand name:
Depakote
Pronounced: DEP-uh-coat
Generic name: Divalproex sodium (Valproic acid)
Why is this drug prescribed?
Depakote, in both delayed-release tablet and capsule form, is used to treat certain
types of seizures and convulsions. It may be prescribed alone or with other
epilepsy medications.
The delayed-release tablets are also used to control the manic episodes--periods
of abnormally
high spirits and energy--that occur in bipolar disorder (manic depression).
An extended-release form of this drug, Depakote ER, is prescribed to prevent
migraine headaches. The delayed-release tablets are also used for this purpose.
Most important fact about this drug
Depakote can cause serious or even fatal liver damage, especially during the first 6
months of
treatment. Children under 2 years of age are the most vulnerable, especially
if they are also taking other anticonvulsant medicines and have certain other disorders
such as mental retardation. The risk of liver damage decreases with age; but you should
always be alert for the following symptoms: loss of seizure control, weakness,
dizziness, drowsiness, a general feeling of ill health, facial swelling, loss
of appetite, vomiting, and yellowing of the skin and eyes. If you suspect a
liver problem, call your doctor immediately.
Depakote has also been known to cause life-threatening damage to the
pancreas. This problem can surface at any time, even after years of treatment.
Call your doctor immediately if you develop any of the following warning
signs: abdominal pain, loss of appetite, nausea, or vomiting.
How should you take this medication?
Take the tablet with water and swallow it whole (don't chew it or crush it).
It has a special coating to avoid upsetting your stomach.
If you are taking the sprinkle capsule, you can swallow it whole or open it and
sprinkle the contents on a teaspoon of soft food such as applesauce or pudding. Swallow
it immediately, without chewing. The sprinkle capsules are large enough to
be opened easily.
Depakote can be taken with meals or snacks to avoid stomach upset.
Take it exactly as prescribed.
--If you miss a dose...
If you take Depakote once a day, take your dose as soon
as you remember. If you don't remember until the next day, skip the missed
dose and return to your regular schedule. Never take 2 doses at the same
time.
If you take more than one dose a day, take
your dose right away if it's within 6 hours of the scheduled time, and take the rest of
the day's doses at equal intervals during the day. Never take 2 doses at the
same time.
--Storage instructions...
Store at room temperature.
What side effects may occur?
Side effects cannot be anticipated. If any develop or change in intensity,
inform your doctor as soon as possible. Because Depakote is often used with
other antiseizure drugs, it may not be possible to determine whether a side
effect is due to Depakote alone. Only your doctor can determine if it is
safe for you to continue taking Depakote.
- More common side effects may include:
Abdominal pain,
abnormal thinking,
breathing difficulty,
bronchitis,
bruising,
constipation,
depression,
diarrhea,
dizziness,
emotional changeability,
fever,
flu symptoms,
hair loss,
headache,
incoordination,
indigestion,
infection,
insomnia,
loss of appetite,
memory loss,
nasal inflammation,
nausea,
nervousness,
ringing in the ears,
sleepiness,
sore throat,
tremor,
vision problems,
vomiting,
weakness,
weight loss or gain
- Less common or rare side effects may include:
Abnormal dreams,
abnormal milk secretion,
abnormal walk,
aggression,
anemia,
anxiety,
back pain,
behavior problems,
belching,
bleeding,
blood disorders,
bone pain,
breast enlargement,
chest pain,
chills,
coma,
confusion,
coughing up blood,
dental abscess,
drowsiness,
dry skin,
ear inflammation,
excessive urination (mainly children) or other urination problems,
eye problems,
feeling of illness,
gas,
growth failure in children,
hallucinations,
hearing problems,
heart palpitations,
high blood pressure,
hostility,
increased appetite,
increased cough,
involuntary rapid movement of eyeball,
irregular or painful menstruation,
itching,
jerky movements,
joint pain,
lack of muscular coordination,
leg cramps,
liver problems,
loss of bladder or bowel control,
muscle or joint pain,
muscle weakness,
muscle pain,
neck pain,
nosebleed,
overactivity,
pneumonia,
rapid heartbeat,
rickets (mainly children),
sedation,
seeing "spots before your eyes",
sensitivity to light,
sinus inflammation,
skin eruptions or peeling,
skin rash,
speech difficulties,
stomach and intestinal disorders,
swelling of arms and legs due to fluid retention,
swollen glands,
taste changes,
tingling or pins and needles,
twitching,
urinary problems,
vertigo,
vision problems
Why should this drug not be prescribed?
You should not take this medication if you have liver disease or your liver
is not functioning well.
If you are sensitive to or have ever had an allergic reaction to
Depakote, you should not take this medication.
Special warnings about this medication
This medication can severely damage the liver (see "Most important fact about this
drug").
Your doctor will test your liver function before you begin taking this medication and at
regular intervals thereafter.
Also remember that the drug can damage the pancreas (see "Most important fact
about this drug"). This problem can worsen very rapidly, so be sure to contact your
doctor immediately if you develop any symptoms.
Depakote causes some people to become drowsy or less alert. You should not drive
or operate dangerous machinery or participate in any hazardous activity that
requires full mental alertness until you are certain the drug does not have
this effect on you.
Do not abruptly stop taking this medicine without first consulting your
doctor. A gradual reduction in dosage is usually required.
Depakote prolongs the time it takes blood to clot, which increases your
chances of serious bleeding.
This drug can also increase the effect of painkillers and
anesthetics. Before any surgery or dental procedure, make sure the
doctor knows you are taking Depakote.
If you are taking Depakote to prevent migraine, remember that it will not
cure a headache once it has started.
Some coated particles from the capsules may appear in your stool. This
is to be expected, and need not worry you.
Possible food and drug interactions when taking this medication
Depakote depresses activity of the central nervous system, and may increase
the effects of alcohol. Do not drink alcohol while taking this medication.
If Depakote is taken with certain other drugs, the effects of either could be
increased, decreased, or altered. It is especially important to check with
your doctor before combining Depakote with the following:
Amitriptyline (Elavil)
Aspirin
Barbiturates such as phenobarbital and Seconal
Blood thinners such as Coumadin
Cyclosporine (Sandimmune, Neoral)
Notriptyline (Pamelor)
Oral contraceptives
Other seizure medications, including carbamazepine (Tegretol), clonazepam
(Klonopin), ethosuximide (Zarontin), felbamate (Felbatol),
lamotrigine (Lamictal), phenytoin (Dilantin), and Primidone (Mysoline)
Rifampin (Rifater)
Sleep aids such as Halcion
Tolbutamide (Orinase)
Tranquilizers such as Valium and Xanax
Zidovudine (Retrovir)
Special information if you are pregnant or breastfeeding
Depakote may produce birth defects if it is taken during pregnancy.
If you are pregnant or plan to become pregnant, inform your
doctor immediately. Depakote appears in breast milk and could affect a
nursing infant. If Depakote is essential to your health, your doctor may
advise you to discontinue breastfeeding until your treatment with this
medication is finished.
Recommended dosage
EPILEPSY
Dosage for adults and children
10 years of age or older is determined by body weight. The usual recommended starting
dose
is 10 to 15 milligrams per 2.2 pounds per day, depending on the type of
seizure. Your doctor may increase the dose at 1-week intervals by 5
to 10 milligrams per 2.2 pounds per day until your seizures are controlled or the side
effects become too severe. The most you should take is 60
milligrams per 2.2 pounds per day. If your total dosage is
more than 250 milligrams a day, your doctor will divide it into smaller
individual doses.
Older adults usually begin taking this medication at lower dosages, and the dosage is
increased more slowly.
MANIC EPISODES
The usual starting dose for those aged 18 and over is 750 milligrams a day,
divided into smaller doses. Your doctor will adjust the dose for best results.
MIGRAINE PREVENTION
Delayed-Release Tablets
The usual starting dose for those aged 16 and over is 250 milligrams twice
a day. Your doctor will adjust the dose, up to a maximum of 1,000 milligrams
a day.
Extended-Release Tablets
The usual starting dose is 500 milligrams once a day for 1 week. The dose may then be
increased to 1000 milligrams once a day.
Depakote delayed-release and extended-release tablets work differently, so
you cannot substitute one type for the other.
Researchers have not established the safety and effectiveness of Depakote for
prevention
of migraines in children or adults over 65.
Overdosage
Any medication taken in excess can have serious consequences. An overdose of
Depakote can be fatal.
If you suspect an overdose, seek medical attention immediately.
- Symptoms of Depakote overdose may include:
Coma,
extreme sleepiness,
heart problems
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