Divalproex Sodium, commonly sold under the brand name Depakote, is an anticonvulsant medication used to treat epilepsy, mood disorders, and migraines. It is important to use this medication as prescribed and consult with your doctor or healthcare provider before starting any other medications (prescribed or over the counter) while taking divalproex sodium, as adverse effects can occur. Never take divalproex sodium without medical advice.

Divalproex sodium brand names

  • Depakote
  • Depakote ER
  • Depakote Sprinkle Capsules

What is divalproex sodium prescribed for?

Divalproex sodium is prescribed as a treatment for both mental and physical health issues:

  • Epileptic seizures, including Simple and Complex Absence Seizures and Complex Partial Seizures
  • Manic episodes within mood disorders such as bipolar disorder
  • Prevention of migraine headaches

Divalproex sodium is not generally prescribed to children under 10 years old, as the safety and efficacy of this medication in pediatric patients is not apparent, and younger children are at greater risk of severe side effects [1].

How does divalproex sodium work?

The exact way that divalproex sodium works is not currently entirely understood, as there are likely various things happening in the brain at once, which is why it can be prescribed for different conditions.

It appears that divalproex sodium causes a change in brain activity that is likely derived from an increase in a neurotransmitter called gamma-aminobutyric acid (GABA). This has various cognitive effects on the brain, such as reducing brain activity and slowing certain aspects of the nervous system [2][3].

Although the mechanisms of the medication are not fully understood, many studies have been conducted to determine how effective it is in treating these symptoms and disorders. It has been found to be very effective for many who use it, although there are risks of side effects that are important to understand prior to the commencement of the treatment [2][4][5][6].

How is divalproex sodium usually taken?

Divalproex sodium comes in delayed-release and extended-release tablets, as well as a delayed-release capsule that can be opened and sprinkled over food for those who struggle to swallow tablets.

Delayed-release tablets are slowly released into the body and doses are usually broken up during the day, while extended-release tablets release the medication into the body throughout the day, so can be given as one daily dose [7]. It is important to be clear about which medication you are prescribed and how it should be taken.

Tablets come in 125mg, 250mg, and 500mg strengths, each of a different color to help you see the different doses, while capsules are 125mg. Tablets must be taken whole and should not be broken or crushed. Capsules should be sprinkled on food and swallowed at once.

Typically, a doctor will start you on a low-dose prescription and increase the dose to find the most effective treatment for you. This may require blood tests to assess the level of medication in your body and to ensure effective treatment [7].

  • For the treatment of epilepsy, you will likely begin with a prescription of around 500-1000mg per day, with a gradual increase. Your prescription could be increased to up to 5000-6000mg per day, if needed.
  • For the treatment of manic episodes, delayed-release prescriptions may start at 750mg per day, broken up into two or three doses, while extended-release prescriptions may start at around 1000-3000mg per day, taken at one time. Your prescription could be increased to up to 5000-6000mg per day, if needed.
  • For the prevention of migraines, you may be prescribed 500-1000mg per day, and this will not increase above 1000mg.

Ensure you take your medication exactly as prescribed, using the correct type of divalproex sodium, the correct dose, and at the correct times.  The exact dosage you need will depend on your body weight, so your doctor may need to make dosage adjustments if you lose or gain weight.

If you forget one dose, take it as soon as you remember, or if it is near the time of your next dose, skip the missed dose and take the next. Never take double your prescribed dose.

How long does divalproex sodium stay in your system?

Once you begin taking divalproex sodium, it will be in the blood within four hours. However, it could take several weeks, or even months, for the full effect of this treatment to take place, so it is important to continue taking it consistently, as prescribed [4].

After your last dose of divalproex sodium, it will take around three to four days to leave your system entirely.

Do not stop taking divalproex sodium suddenly, as this can cause severe health issues. Consult your doctor if you wish to come off this medication, so it is reduced safely. If it is taken as an antiepileptic drug to treat seizures, a sudden stop in medication can cause severe types of seizures to occur.

Divalproex sodium side effects

Divalproex sodium may cause side effects within the first few months of treatment [7][8]. Common side effects include:

  • Nausea, vomiting, or diarrhea
  • Headaches
  • Trouble falling asleep or staying asleep
  • Changes in appetite and weight
  • Dizziness, blurred vision, or drowsiness

Serious side effects can also occur, which may require medical intervention or changes to your prescription. If you experience any of the following severe symptoms, consult your doctor immediately:

  • Liver issues: reduced appetite, severe abdominal pain, jaundice (yellowing skin or eyes)
  • Pancreas issues: consistent nausea or vomiting, severe stomach pain
  • Blood issues: bruising, swelling of the face or joints, red or purple spots appearing
  • Hypothermia (body temperature below 95 F): tiredness, confusion
  • Allergic reaction: rash, swelling, breathing difficulties, sores
  • Excessive fatigue or tiredness
  • Chest pain

Divalproex sodium can also cause significant mental health changes. Consult your doctor if you experience any of the following:

  • Anxiety
  • Depression
  • Thoughts of harming yourself or others
  • Difficulty sleeping or staying asleep
  • Angry or violent behavior
  • Impulsive or manic behavior
  • Abnormal dreams

Divalproex sodium precautions

Due to the way this medication is absorbed into the body through the liver, you must inform your doctor if you have any previous liver problems, as you may not be able to take this medication safely.

There have been cases of severe and fatal liver damage and pancreatitis in individuals within the first six months of taking this medication [4]. Consult your doctor if you experience any concerning side effects.

Discuss with your doctor all your current and previous physical and mental health conditions, as this may impact your ability to take this medication safely.

Tell your doctor about all medications you are currently taking or plan to take (including vitamins and dietary supplements), as they may cause adverse reactions.

Divalproex sodium can be very dangerous for pregnant women and their fetus as prenatal exposure can increase the risk of birth defects. Do not take this medication if you are pregnant or plan on soon becoming pregnant. Women of childbearing age are advised to use effective contraception while using this medication to prevent unexpected pregnancy [1]. There are alternative medications you can take if required.

Divalproex sodium can make you more susceptible to sunburn, so it is advised to be very careful in the sun when taking this medication.

Divalproex sodium interactions

Because of the possible side effects of divalproex sodium, it is essential to discuss your current medications with your doctor.

Some antidepressants, antibiotics, anticonvulsants, blood thinners, and tranquilizers may interact with divalproex sodium, causing increased or decreased levels of medication in your body, confusion, drowsiness, or risks of physical or mental health problems.

Alcohol and recreational drugs can also interact with divalproex sodium and increase health risks such as liver disease, confusion, and drowsiness, and can impact how well the medicine works for you.

Divalproex sodium storage

Always keep all medications out of reach of children.

Store divalproex sodium in its original packaging, in airtight containers, and at room temperature (never above 86 F).

If you need to dispose of medication that is out of date or no longer needed, contact a medical professional to ensure it is disposed of appropriately. Never flush medications down the toilet or put them in the bin, as this can create unnecessary risks.

What to do if you overdose on divalproex sodium

If you overdose on divalproex sodium, call a medical professional or Poison Control on 1-800-222-1222, or in case of an emergency, call 911. A severe overdose may cause loss of consciousness or heart irregularities.

FAQs about divalproex sodium

What is the difference between divalproex sodium and valproic acid?

These two medications are basically the same, although valproic acid has a tendency to be metabolized more quickly than divalproex sodium, so patients taking that medication may need higher doses. Divalproex sodium is a brand name, while valproic acid is a more generic medication, so is cheaper, but they work in the same way and are similarly effective [5].

Can I share my medication with someone else?

You should never give your medication to anyone else, even if you think it may help them. Instead, they should consult their doctor to ensure they receive the correct medication and treatment, as they may require an alternative treatment option to you, so this could be harmful.

Resources:

  1. US Food & Drug Administration (FDA). (n.d.). Medication Guides. FDA. Retrieved from https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm?event=medguide.page
  2. Pinder, R. M., Brogden, R. N., Speight, T. M., & Avery, G. S. (1977). Sodium Valproate: A Review of its Pharmacological Properties and Therapeutic Efficacy in Epilepsy. Drugs13(2), 81–123. Retrieved from https://doi.org/10.2165/00003495-197713020-00001
  3. Epilepsy Foundation. (n.d.). Divalproex Sodium. Epilepsy Foundation. Retrieved from https://www.epilepsy.com/tools-resources/seizure-medication-list/divalproex-sodium
  4. The College of Psychiatric and Neurologic Pharmacists (CPNP) and the National Alliance on Mental Illness (NAMI). (2021). Valproate (Depakote). NAMI. Retrieved from https://www.nami.org/About-Mental-Illness/Treatments/Mental-Health-Medications/Types-of-Medication/Valproate-(Depakote)
  5. Schwartz, T. L., Massa, J. L., Gupta, S., Al-Samarrai, S., Devitt, P., & Masand, P. S. (2000). Divalproex Sodium Versus Valproic Acid in Hospital Treatment of Psychotic Disorders. Primary Care Companion to the Journal of Clinical Psychiatry2(2), 45–48. Retrieved from https://doi.org/10.4088/pcc.v02n0203
  6. Stoner, S. C., & Dahmen, M. M. (2007). Extended-Release Divalproex in Bipolar and Other Psychiatric Disorders: A Comprehensive Review. Neuropsychiatric Disease and Treatment3(6), 839–846. Retrieved from https://doi.org/10.2147/ndt.s1264
  7. AbbVie Inc. (2020). Prescribing Information. Depakote. Retrieved from https://www.depakote.com/prescribing-information
  8. National Library of Medicine. (2019). Valproic Acid. MedlinePlus. Retrieved from https://medlineplus.gov/druginfo/meds/a682412.html
  9. Holquist, C. & Fava, W. (July 2007). FDA Safety Page: Delayed-Release vs. Extended-Release Rxs. Drug Topics. Retrieved from https://www.drugtopics.com/view/fda-safety-page-delayed-release-vs-extended-release-rxs