What Meds

Psychiatric Medications


Sodium Divalproex
Brand Names: Depakote, Depakote Sprinkle, Depakene (Valproic Acid),
Depacon (Valproate)

Overview
Depakote is a brand name for sodium divalproex, a compound made of sodium valproate and valproic acid. This drug is an anticonvulsant and mood stabilizer, and is used to treat several conditions. This medication blocks voltage sensitive sodium channels, and increases GABA (a neurotransmitter) in the brain. It suppresses the spread of abnormal electrical discharges, relieving the symptoms of disorders such as epilepsy, bipolar disorder, and migraine headaches.  

When taken to treat epilepsy, it may take one to two weeks for Depakote to reduce the incidence of seizures.

Why is this drug prescribed?
Depakote is FDA-labeled in adults for absence seizures, complex partial epileptic seizures, bipolar I mania, migraine prevention, other seizures. It is FDA-labeled in children for absence seizures, partial epileptic seizures (age 10 years and older), other seizures. There is also some evidence that favors usage for bipolar disorder, adjunctive therapy for schizophrenia, myelodysplastic syndrome, and myoclonic seizures in adults.

Depakote is also used to treat the following conditions:

How much of this drug is typically used?
Capsule: 250 mg
Capsule, sprinkles: 125 mg
Injection, solution: 100 mg/mL (5 mL)
Syrup: 250 mg/5 mL
Tablet, delayed release: 125 mg, 250 mg, 500 mg
Tablet, extended release: 250 mg, 500 mg

Warnings and Precautions
Stopping this medication abruptly could cause physical and psychological withdrawal symptoms. If Depakote is being used to treat epilepsy (seizures), the patient should not stop taking it suddenly — this increases the risk of seizures. Patients are advised to wear a Medic Alert bracelet or necklace while taking Depakote.

Depakote may cause drowsiness, dizziness, or blurred vision. Patients taking Depakote should not drive, use machinery, or do anything requiring mental alertness until the effects of this drug are known.

Children up to 2 years of age, those taking more than one medicine for seizure control, and children with other medical problems are more likely to develop serious side effects. Abdominal or stomach cramps, nausea or vomiting, tiredness or weakness, and

yellow eyes or skin are more likely to occur in children than in adults taking Depakote, especially those known to be sensitive to this type of medication.

Depakote can cause blood problems that slow the rate of healing and increase the patient’s risk of infection. Patients should be especially careful when brushing and flossing teeth.

For Pregnant or Nursing Mothers: Pregnant women should not take Depakote as it is reported to cause birth defects when taken during the first trimester. Depakote passes into breast milk, though its effects on infants are not known.

Contraindications
Depakote should Not be used for people who have:

Adverse Reactions
Depakote may cause the following reactions:

Rarely:

Interactions with Drugs and Other Substances
Drugs or substances that may interact with Depakote include:

Research Studies and Use in Child Psychiatry
Small open label trials of valproate monotherapy support its effectiveness in treatment of youths with mania due to bipolar disorder. However, a large, multi-center placebo-controlled trial found extended-release divalproex (Depakote ER) no better than placebo for treating pure or mixed mania in children and adolescents 10-17 years old. In other open studies, no difference in effectiveness was found between valproate and lithium for maintenance treatment of pediatric bipolar I or II in a double-blind, randomized study. Other studies have shown valproate to be more effective than lithium in the treatment of mixed states in children. In addition, several other studies have shown combination of valproate with an atypical antipsychotic to show significant difference in response rates than valproate alone. Thus, despite the negative data with Depakote ER, this medication is still used in children and adolescents with bipolar disorder. It is also sometimes used for behavioral problems in children, such as conduct disorder, or intermittent explosive disorder.

Not generally recommended for use under age 10 for bipolar disorder except by experts and when other options have been considered. Safety and efficacy of this drug have not been fully established in children and adolescents. The medication carries a special warning, as with other antiepileptics, of increased suicidal thinking and behavior in children, adolescents and young adults.

There is also some evidence that favors the usage for migraine prevention and disruptive behavioral disorders in children.

Sources

Stanford Medicine Resources:

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