Depakote Generic is a drug containing an active substance that is called Divalproex sodium. Depakote is degraded in the gastrointestinal system into the valproic acid, which acts as an anticonvulsant. Therefore, Depakote Divalproex is used to treat epilepsy. The precise mechanism, through which the drug works, has not been established yet, but the FDA considers increasing the concentration of gamma aminobutyric acid (GABA) in the brain is the main mechanism of the Depakote efficacy.

This drug binds to the plasma protein from 10-18% and its binding is reduced in patients who are older than 65 years, in patients with impaired renal function, in patients with impaired liver function, or in individuals taking Aspirin.

Depakote Divalproex may also displace some drugs from plasma proteins, including Tolbutamide, Carbamazepine, and Warfarin. This means that this medicine increases plasma levels of mentioned drugs, thus increasing the risk of their side effects.

Almost the whole dose of Depakote is metabolized by the liver and eliminated through feces.

Indications

Depakote Divalproex is indicated for treatment of mania, epilepsy and migraine.

Safety and efficacy of Depakote in the treatment of mania was established in clinical trial that lasted for 21 days. This trial was conducted on patients who were suffering from acute mania episodes and were hospitalized. Depakote Divalproex may also be used as a monotherapy or in combination with other drugs to treat epilepsy. Its efficacy was established in 5 double-blind, randomized clinical studies conducted on total of 563 patients.

Depakote is used as a prophylactic treatment of migraine. It is not indicated for acute migraine attacks.

Warnings

Depakote Divalproex is absolutely contraindicated in patients who have urea cycle disorders, or have known hypersensitivity on Divalproex or Valproate. If you notice symptoms of an allergic reaction, you must call your doctor immediately (swelling of the face, swelling of the lips, swelling of the throat, skin rash, and difficulty breathing).

Hepatic failure resulting in death has been reported in patients taking Depakote Generic. Risk of hepatic failure is higher in the first six months of the therapy. If you notice non-specific symptoms of hepatic failure, such as fatigue, malaise, vomiting, and anorexia, you should inform your doctor. Call your physician at once if you notice severe pain in upper abdomen and jaundice (yellow eyes). It is recommended to evaluate liver function prior starting the Depakote treatment. Testing for liver enzymes (AST and ALT) should be performed once a month during the course of the treatment, and if elevation of these enzymes is noticed, the discontinuation of treatment should be considered.

Cases of pancreatitis (including the life-threatening cases) have been reported in patients taking Depakote Divalproex. If you notice the following symptoms of pancreatitis: upper abdominal pain, fever, rapid heartbeat, nausea, vomiting, and swelling of the abdomen - you must call your doctor immediately. Pancreatitis may rapidly progress and may be fatal!

Hyperammonemic encephalopathy has been reported in patients who suffer from urea cycle disorder and take this drug. Encephalopathy is a sever condition that may be fatal!

Those who are taking Depakote Divalproex may experience side effects, such as suicidal thoughts and ideation. If you notice these symptoms, inform your doctor immediately.

Depakote Generic may reduce number of platelets in the blood thus leading to more frequent bruising and bleeding. If you notice these symptoms, call your physician immediately. The risk of this side effect is higher in patients taking high doses.

Use of Depakote Divalproex during Pregnancy and Breastfeeding

Depakote Generic is contraindicated for use in pregnant and breastfeeding women. Clinical studies have shown that the drug exerts teratogenic effects and may cause congenital malformations in fetus. However, benefits of taking Depakote Divalproex during pregnancy may sometimes outweigh the risks to the fetus, so your doctor may prescribe you this medicine during pregnancy. Always consult your doctor before starting any medication during pregnancy.

What Dosage to Take

Depakote tablets are taken by oral route. The recommended starting dose in patients suffering from mania is 750mg daily in three divided doses. The dosage can be increased up to 60mg/kg/day until an appropriate therapeutic effect is achieved.

The dose of Depakote Divalproex in the treatment of epilepsy depends on whether you are already taking any anticonvulsant drugs. Your doctor will tell you what dose to take. Usual initial dosage when used as a monotherapy is 10-15mg/kg/day divided in 2-3 doses.

The recommended dose for prophylactic treatment of migraine is 250mg two times a day. It may be increased up to 1000mg daily.

The dosage should be reduced in patients older than 65 years.

You should swallow the Depakote tablet whole and avoid chewing the tablet. If you are not sure how should you take this drug, you should ask your doctor or pharmacist.

Side Effects

Depakote Divalproex may cause following side effects:

• Asthenia;
• Abdominal pain;
• Dyspepsia;
• Skin rash;
• Fainting;
• Somnolence;
• Nausea;
• Vomiting;
• Chest pain;
• Chills, fever;
• High blood pressure;
• Low blood pressure;
• Flatulence;
• Increased heart rate;
• Vasodilation - widening of blood vessels;
• Glossitis;
• Periodontal abscess;
• Pain in the muscles;
• Pain in the joints;
• Edema;
• Hypertonia;
• Hypokinesia;
• Confusion;
• Depression;
• Tinnitus;
• Eye pain;
• Double vision;
• Hallucinations;
• Abnormal dreams;
• Insomnia;
• Tremor;
• Paresthesia;
• Allergic reactions.

Inform your doctor if you notice any mentioned adverse effects.

Drug Interaction

There are 22 major, 679 moderate, and 50 minor interactions reported so far. Depakote Divalproex should not be used concomitantly with following drugs:

• Teriflunomide (Aubagio) and Leflunomide (Arava) - drugs used to treat rheumatoid arthritis. The concomitant use may lead to liver damage.
• Sodium phenylacetate (Ammonul) - a drug used to treat acute hyperammonemic episodes in children and adults. The concomitant use may increase levels of ammonium in the blood and cause severe side effects.
• Propoxyphene - a drug used to treat severe pain. It may lead to dizziness, emotional lability, suicidal thoughts, confusion, and other adverse effects.
• Bexarotene - a drug used to treat lymphoma that can increase the risk of pancreatitis.
• Doripenem - a drug used to treat infections. It reduces levels of Depakote in the blood thus resulting in decreased Depakote's effectiveness.

Inform your doctor about all medicines you are currently taking.