Like many other medicines, Depakote is broken down digested in the liver. People with liver disease should not take it. Anyone who also takes other medicines that are digested in the liver need to be careful. How well each medicine works and how quickly it leaves the body may be changed. This is why the doctor needs to know about everything that a person takes—not just prescription medicines but even things like vitamins, herbs, and aspirin!
These things can affect how much Depakote the doctor prescribes. Doctors have studied large numbers of people to find out how well Depakote and the other medicines that contain valproate control seizures. There is hardly any difference in the way the different valproate medicines work. They have reported that Depakote is very good at completely controlling absence seizures in many people who take it. These promising results are not always matched in everyday life. Sometimes people don't take all their medicine on time.
Not everyone's seizures can be controlled at a dose that can be taken without side effects. Because of individual differences, there is no "best" amount for everyone. Adjustments are often needed to reduce seizures or side effects. In studies of seizure medicines, some people do better with Depakote and others do better with something else. It's difficult to forecast the results for any given person.
Differences in side effects may be important in deciding which medicine is best for each person. If seizures continue, the doctor probably will change the amount of Depakote prescribed.
If that doesn't work, the next step may be either to prescribe a different seizure medicine by itself or to prescribe a combination of Depakote and another seizure medicine. Many are available. No single combination is best for everyone. Depakote is often used as an "add-on" medicine for people who continue to have certain kinds of seizures while taking other seizure medicines. Most people who take Depakote don't have too much trouble with side effects. That's one of the reasons it's used so much.
The most common complaints usually not too severe are:. If you notice any of these problems, call the doctor. Sometimes the doctor can help by changing the amount or type of Depakote prescribed. No one should stop taking Depakote or change the amount they take without their doctor's guidance. Stomach upset from Depakote may be less of a problem if the pills are taken on a full stomach. Stomach upset is more likely when another seizure medicine with similar side effects for example, Tegretol is also being used.
Tremor shaking of the hands or other body parts tends to be worse when the level of Depakote in the blood is highest, a few hours after the pills are taken. Anxiety or caffeine also may make it worse. It is more common in adult women but can affect anyone. The average gain for adults is 15 pounds. Exercise and a reduced-calorie diet can be very helpful. It's uncertain whether weight gain is greater when higher doses of Depakote are taken. The hair almost always grows back after the Depakote is stopped, but it often has a different texture.
For example, it may grow in curly instead of straight. People who have just started taking Depakote or who have just started taking a larger amount should be careful during activities that might be dangerous, until they know whether they are having any side effects. Allergic reactions such as rashes are less common with Depakote than with most other seizure medicines. Even so, you should report any rash to the doctor or nurse right away, especially if Depakote treatment has just begun.
It's rare for the rash to be serious, but don't ignore it. It's often necessary to switch to a different seizure medicine. A very small number of people who take Depakote develop life-threatening disorders. Children younger than 2 years of age and other people who are taking more than one seizure medicine have the greatest risk. See Serious side effects.
Some people who have taken Depakote for many years have experienced bone loss and a few other disorders. Taking both calcium and vitamin D may help to prevent this kind of problem. Doctors sometimes recommend a bone density test to identify which people need treatment for bone loss. A few people have serious reactions to Depakote. These problems are very rare but everyone who takes this medicine should at least be aware of them because a very small number of people have died because of them.
Here's a list of warning signs that may be the start of one of these problems. If you notice any of these things, call the doctor immediately:. Tell the doctor right away if you notice any of these problems, but don't stop using the Depakote unless the doctor says so. The best-known and most-feared serious reaction is liver failure. This disorder usually occurs within the first 6 months of treatment.
The risk of liver failure is much higher in children under 2 years of age, especially if they also take other seizure medicine or already have other serious disorders. The risk of liver failure is much lower in children between 2 and The risk is very low in older children and adults, perhaps 1 in 50, There is no evidence that long-term use of Depakote will cause gradual damage to the liver.
Another rare reaction to Depakote is a disorder of the pancreas. Depakote is the brand name used in the United States for divalproex sodium, a compound of sodium valproate and valproic acid. The same product is known as Epival in Canada. Divalproex sodium dissociates to the valproate ion in the gastrointestinal tract, so its effects are virtually identical to those of other forms of valproate.
Depakote has been marketed in the United States since It is also available in an extended-release form, Depakote ER. Divalproex sodium is not available in generic form. Depakote is indicated for use as an anticonvulsant drug in people of all ages. It is used mainly as monotherapy or adjunctive therapy for simple or complex absence seizures, either alone or with other seizure types such as for juvenile myoclonic epilepsy.
It is also effective for partial seizures. Depakote is marketed in the United States by Abbott Laboratories. The name or appearance may differ in other places.
These descriptions apply to the U. All forms of Depakote can be taken either with food or without food, but many patients find that taking the tablets with food helps to avoid gastrointestinal irritation. The sprinkle capsule is a way for small children or older people who have trouble swallowing pills to take Depakote. It can be swallowed whole, but it also can be opened and the contents sprinkled onto a teaspoon of soft food such as applesauce, custard, ice cream, oatmeal, pudding, or yogurt.
After combining the two, the entire spoonful should be swallowed right away and not chewed. Drinking a glass of water or another fluid may help with swallowing. Both forms should be kept away from light and dampness. In general, tell patients that if they forget a dose, they should take it as soon as they remember. If it is almost time for the next dose, they should delay that dose for a few hours, instead of taking two doses very close together. Patients who often forget doses may benefit from using a special pillbox or watch with an alarm.
Switching to a once-a-day extended-release form in the U. Valproate differs in structure from other antiepileptic drugs in common use. The way in which valproate works is not fully understood, but it appears to involve several mechanisms and to act on a variety of targets, probably accounting for its broad efficacy:. Depakote is quickly absorbed when taken by mouth.
The delay that occurs when it is taken with food is not important during long-term treatment, but it could have some effect when treatment is first begun. Food has more effect on the rate of absorption of tablets than it does for sprinkle capsules. Without food, peak levels in the blood are reached in 4 hours for tablets and 3. With food, reaching the peak level takes 8 hours for tablets and 4. This increase could be associated with improvement in seizure control and worsening of side effects in the body and brain.
Many metabolites are produced, and some of them have longer half-lives than the original drug. Some metabolites may contribute to the efficacy and side effects.
The half-life ranges from 8 to 16 hours, with shorter times in children and longer times in the elderly. The differences between peak and trough levels can be marked. In some cases the peak level is more than double the trough level. Because this medication is metabolized in the liver, Depakote should not be administered to patients with hepatic disease or significant hepatic dysfunction.
In children, steady state is reached after about 2 days of taking a stable dose of Depakote. It takes about 5 days for the same thing to happen in seniors. After steady state is achieved, the levels of medication in the blood can be expected to be fairly constant. The dose that a patient takes should not be increased until steady state has been reached or some time later , so that the effects of the previous dose can be assessed.
Photosensitivity is easily controlled by valproate. This medication also seems to be effective in controlling the seizures of juvenile myoclonic epilepsy and myoclonic seizures from other causes, such as benign myoclonic epilepsy of infancy. Epilepsy syndromes that involve symptomatic generalized seizures, such as infantile spasms and Lennox-Gastaut syndrome, are less well controlled by valproate or any other medication.
Nevertheless, valproate is usually regarded as the first choice for treating these conditions. Some patients do experience substantial improvement and may be able to reduce their use of other seizure medicines that have more troubling side effects. Researchers looked at whether valproate alone can be used effectively to treat partial seizures. In one large double-blind trial Mattson et al.
Differences in the side effects need to be considered in choosing medication for each patient. If Depakote alone does not fully control the patient's seizures, a combination of Depakote and another seizure medicine may be more effective. Factors influencing the choice of the additional medication may include potential interactions and the mechanisms of action of the two medications. No single combination is perfect for everyone.
Sometimes a series of combinations must be tried before finding what is best for the individual patient. Depakote is often used as an "add-on" medication for patients who continue to have complex partial seizures while taking other seizure medicines.
In one study, such patients were given either Depakote or a placebo in addition to the Dilantin or Tegretol carbamazepine that they had been taking.
The number of seizures they experienced during the 8 weeks they added either Depakote or a placebo was compared to the number they had during the preceding 8 weeks, when they were taking only Dilantin or Tegretol. These defects occur in 1 to 2 out of every babies born to mothers who use this medicine during pregnancy. These defects can begin in the first month, even before you know you are pregnant.
Other birth defects that affect the structures of the heart, head, arms, legs, and the opening where the urine comes out urethra on the bottom of the penis can also happen. Birth defects may occur even in children born to women who are not taking any medicines and do not have other risk factors. Taking folic acid supplements before getting pregnant and during early pregnancy can lower the chance of having a baby with a neural tube defect.
There may be other medicines to treat your condition that have a lower chance of causing birth defects, decreased IQ, or other disorders in your child. All women of childbearing age including girls from the start of puberty should talk to their healthcare provider about using other possible treatments instead of DEPAKOTE. You can enroll in this registry by calling toll-free or by visiting the website, www.
The purpose of this registry is to collect information about the safety of antiepileptic drugs during pregnancy. Call your healthcare provider right away if you have any of these symptoms: severe stomach pain that you may also feel in your back, nausea or vomiting that does not go away.
Call a healthcare provider right away if you have any of these symptoms, especially if they are new, worse, or worry you: thoughts about suicide or dying; attempts to commit suicide; new or worse depression; new or worse anxiety; feeling agitated or restless; panic attacks; trouble sleeping insomnia ; new or worse irritability; acting aggressive, being angry, or violent; acting on dangerous impulses; an extreme increase in activity and talking mania ; other unusual changes in behavior or mood.
How can I watch for early symptoms of suicidal thoughts and actions? Keep all follow-up visits with your healthcare provider as scheduled. Call your healthcare provider between visits as needed, especially if you are worried about symptoms. Ask your healthcare provider about the best way to feed your baby. DEPAKOTE can cause other serious side effects, including: Bleeding problems: red or purple spots on your skin, bruising, pain and swelling into your joints due to bleeding or bleeding from your mouth or nose.
High ammonia levels in your blood: feeling tired, vomiting, changes in mental status. Allergic hypersensitivity reactions: fever, skin rash, hives, sores in your mouth, blistering and peeling of your skin, swelling of your lymph nodes, swelling of your face, eyes, lips, tongue, or throat, trouble swallowing or breathing. Drowsiness or sleepiness in the elderly. This extreme drowsiness may cause you to eat or drink less than you normally would. Tell your doctor if you are not able to eat or drink as you normally do.
Common side effects of DEPAKOTE include: nausea vomiting dizziness double vision weight gain problems with walking or coordination headache weakness stomach pain diarrhea hair loss sleepiness tremor blurry vision increased appetite loss of appetite.
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www. If you are having difficulty paying for your medicine, AbbVie may be able to help.
Visit Abbvie. If you have any questions about AbbVie's Depakote. This website and the information contained herein is intended for use by US residents only, is provided for informational purposes only, and is not intended to replace a discussion with a healthcare provider. All decisions regarding patient care must be made with a healthcare provider and consider the unique characteristics of each patient. You are leaving the AbbVie website and connecting to a site that is not under the control of AbbVie.
AbbVie is not responsible for the contents of any such site or any further links from such site. AbbVie is providing these links to you only as a convenience and the inclusion of any link does not imply the endorsement of the linked site by AbbVie. You should also be aware that the linked site may be governed by its own set of terms and conditions and privacy policy for which AbbVie has no responsibility. You are about to enter a site that is for U. Healthcare Professionals only. By selecting "Yes" below, you certify that you are a Healthcare Professional and that you wish to proceed to the Healthcare Professionals Only section of this site.
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Health insurance that you or a family member obtained through an employer or purchased privately. The DEPAKOTE Savings Card is not available to individuals who are paying cash for their prescription or who are receiving prescription reimbursement under a state or federally funded insurance program.
This rebate form is not available to individuals who are paying cash for their prescription or who are receiving prescription reimbursement under a state or federally funded insurance program.
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