Divalproex Sodium

💊 What is Divalproex Sodium used for?

• •Manic episodes associated with bipolar disorder
• •Complex partial seizures, alone or with other medicines
• •Simple and complex absence seizures, alone or with other medicines
• •Prevention (prophylaxis) of migraine headaches. The label says it is not useful for treating a migraine that has already started.

How it works

How it is usually taken

• •Swallow the tablets whole. Do not crush or chew them.
• •Take the medicine every day as prescribed. The label describes it as given in divided doses.
• •The label says that if a dose is missed, it should be taken as soon as possible, unless it is almost time for the next dose. The next dose should not be doubled.
• •Follow the instructions from your prescriber or pharmacist about how much to take and how often.

Comes as

• •Delayed-release tablets, 125 mg, 250 mg, and 500 mg (strengths given as valproic acid equivalents)
• •The 500 mg tablet is pink, oval, and enteric-coated, with 'D 86' imprinted on one side

⚠️ Divalproex Sodium side effects

🛑 Who should not take Divalproex Sodium, and who should be careful

The label says not to take it if

• 🚨You have hepatic (liver) disease or significant liver dysfunction
• 🚨You have a known mitochondrial disorder caused by POLG gene mutations (for example, Alpers-Huttenlocher Syndrome)
• 🚨You are a child under two years old who is suspected of having a POLG-related disorder
• 🚨You have had a known allergic-type reaction to divalproex sodium, sodium valproate, or valproic acid. The label lists reactions such as multiorgan hypersensitivity, serious skin reactions, and swelling (angioedema).
• 🚨You have a urea cycle disorder
• 🚨You are being treated to prevent migraine and are pregnant, or are a woman of childbearing potential who is not using effective birth control

Tell your doctor before taking it if

• •Tell your prescriber about any history of liver disease, mitochondrial disorders, or urea cycle disorders.
• •Liver blood tests are done before treatment and at frequent intervals afterward, especially in the first six months.
• •Blood tests to check platelet counts and clotting are monitored, according to the label.
• •Tell your prescriber if you are pregnant, may become pregnant, or are of childbearing potential. The label has specific warnings about pregnancy and birth control.
• •The label notes reports of male infertility during treatment.
• •Do not stop the medicine without first talking to your healthcare provider. The Medication Guide says stopping suddenly can cause serious problems, including seizures that will not stop in people with epilepsy.
• •Keep all follow-up visits. Tell your provider about mood changes or new thoughts of self-harm.

🔀 Divalproex Sodium with other medicines, food and alcohol

The label says to discuss these with your doctor or pharmacist

• •Medicines that speed up liver breakdown of valproate (enzyme inducers) include phenytoin, carbamazepine, phenobarbital, primidone, and rifampin. Medicines that slow it (enzyme inhibitors) include felbamate. The label says valproate levels and dose adjustments may be needed when these are started or stopped.
• •Aspirin, carbapenem antibiotics, estrogen-containing hormonal birth control, and methotrexate: the label recommends monitoring valproate levels.
• •Valproate can affect how other medicines work, including diazepam, ethosuximide, lamotrigine, and phenytoin.
• •Rufinamide: people already on rufinamide should start valproate at a low dose and build up to an effective dose.
• •Amitriptyline, nortriptyline, propofol, warfarin, and zidovudine may need dose changes if used with this medicine.
• •Topiramate can raise the risk of high ammonia levels and brain problems (encephalopathy). The label also lists low body temperature (hypothermia) with topiramate.
• •Cannabidiol can raise ALT and AST liver test results.

Alcohol and food

The label does not say.

🤰 Divalproex Sodium in pregnancy and breastfeeding

Pregnancy

The boxed warning says this medicine can harm an unborn baby. Taking it during pregnancy for any condition raises the risk of birth defects, especially neural tube defects such as spina bifida, and of lower IQ, autism, and attention deficit/hyperactivity disorder in the child. The label says women who are pregnant must not take it to prevent migraines. For epilepsy or bipolar disorder, it should not be used in pregnant women or women who plan to become pregnant unless other medicines have failed or are unacceptable. Women of childbearing potential should use effective birth control. Folic acid before pregnancy and in early pregnancy can lower the chance of neural tube defects. The label says women with epilepsy who become pregnant should not stop valproate abruptly. Women who become pregnant are encouraged to join the North American Antiepileptic Drug (NAAED) Pregnancy Registry at 1-888-233-2334.

Breastfeeding

The label does not say.

🗓️ Storage, missed doses and taking too much

Storage

Store at 20° to 25°C (68° to 77°F). Short excursions to 15° to 30°C (59° to 86°F) are permitted.

If a dose is missed

The label says to take a missed dose as soon as possible, unless it is almost time for the next dose. Do not double the next dose. Follow your prescriber or pharmacist's instructions.

If too much is taken

The label says overdose may cause sleepiness (somnolence), heart block, deep coma, and high sodium levels in the blood (hypernatremia). Deaths have been reported. This is an emergency. Get medical help right away.

🗒️ Questions to ask about Divalproex Sodium

• Why am I on this medicine, and is it for seizures, bipolar mania, or migraine prevention?
• How often will I need liver blood tests, and what should I do if I notice warning signs?
• What birth control should I use while taking this medicine, and what should I do if I become pregnant?
• Do any of my current medicines interact with divalproex sodium?
• What should I watch for in my mood, thoughts, and behavior while on this medicine?
• What should I do if I miss a dose, and what is the plan if I need to stop?
• Am I at higher risk because of a history of liver disease, pancreas problems, or a mitochondrial disorder?

❓ Divalproex Sodium: frequently asked questions