Depakote (divalproex)

Depakote Description

Depakote is a drug, which is prescribed frequently for the treatment of bipolar disorder. Depakote is the trade name of Valproate semisodium. Valproate is a compound consisting of sodium valproate and valproic acid. Depakote is marketed in the United States by Abbott Laboratories. It is sold commercially as an enteric-coated tablet.

Bipolar disorder is a type of mood disorder that is characterized by episodes of abnormal energy levels. This abnormal level of energy is commonly referred to as Mania. Depakote is used for the treatment of these manic bouts.

Conditions Treated by Depakote.

Depakote is administered for the treatment of manic bouts characteristic of bipolar disorder. It may also be used concomitantly with other drugs for the treatment of various types of seizures. It is also used for the prevention of migraine headaches in some cases.

Valproate semisodium undergoes dissociation in the gastrointestinal tract to give valproate ions. The mechanism by which the drug exerts its action is unknown. However, it has been predicted that it might increase the concentration of gamma-aminobutyric-acid (GABA) in the brain. This might be the reason for its activity in case of epilepsy.

Depakote Dosage Information

Depakote is marketed in the form of slow-release tablets. They are available in 3 doses: 125, 250 and 500 mg.

a.) Typical Dosage Recommendations

For the treatment of mania associated with bipolar disorder, the recommended initial starting dose is 750mg daily. This is to be given in divided doses. The lowest dosage at which the desired effect is seen is then achieved by rapidly increasing the dosage. This is usually within 14 days. The maximum dosage, however, should not exceed 60mg/kg/day.

For the treatment of epilepsy, Depakote may be administered individually as monotherapy or as adjunctive therapy along with other drugs. For both monotherapy and adjunctive therapy, the recommended initial dose is 10 to 15 mg/kg/day. The dosage can be increased by 5 to 10 mg/kg every week. The daily dose however should not exceed 60mg/kg. If Depakote is being used as a part of adjunctive therapy for the treatment of epilepsy, then required dosages of the other drugs will be affected as Depakote is titrated upwards.

For the treatment of migraine, the recommended starting dosage is 500mg daily. This is to be administered in to two doses of 250 mg each.

b.) Missing a Dose

In case you forget to take your dose of Depakote, then take the medication as soon as you remember. However, if it is nearly time for your next dose, then you should skip the missed dose. Do not overdose to make up for the missed dose.

c.) Overdosing

Overdosage of Depakote may result in somnolence and deep coma. It may also cause fatalities. Hence, it is important that you seek medical attention immediately. In case of overdosage, the amount of free Depakote present in the blood is high. Hence, hemodialysis will help in removal of the excess drug.

Depakote Warnings

Depakote is known to cause hepatic failure in some individuals. This may or may not be failure. Hepatic failure is preceded by symptoms such as weakness, anorexia, vomiting and facial edema, which are not characteristic of hepatic failure.Similarly, pancreatitis has also been reported in some cases. It may or may not be fatal.

Hyperammonemic encephalopathy is a urea cycle disorder. It may or may not be fatal. It has been reported in patients who have initiated therapy with Depakote.

The usage of Depakote is to be strictly avoided in case of pregnancy. It can affect the growth and development of the embryo. It causes congenital malformations. However, in case of pregnancy, stopping the medication abruptly might lead to a relapse of seizures.

Patients, who are being administered Depakote, are at a higher risk of developing suicidal thoughts. Therefore, the patients need to be scrutinized for the development of such thoughts and the worsening of depression.

The drug is known to interact with antibiotics belonging to the class of carbapenems. These antibiotics bring down the levels of Depakote in the serum to very low levels. This may lead to loss of control over seizures.

Depakote Side Effects

Like most other drugs, Depakote too has certain side effects. The side effects can be classified into two groups. The minor side effects of Depakote include:

• gastrointestinal problems such as diarrhea or constipation
• emotional changes such as anxiety, depression

Other minor side effects include:

• tremors
• drowsiness

However, if these symptoms persist for long or they become more severe in nature, then you must consult your doctor immediately. The more severe and serious side effects of Depakote include:

• hallucinating and double vision
• weakness followed by vomiting or fainting
• fever, sore throat and headaches
• skin rashes

If you suffer from any of these major side effects of the drug, then you must seek medical attention immediately

Possible Drug Interactions with Depakote

It is known to interact with a large number of drugs. Out of these 13 interactions are major interactions where as a vast majority is moderate and a remaining few are minor interactions.

Certain drugs increase the clearance of Depakote from the body. These drugs act mainly on the hepatic enzymes and increase their levels.

Co-administration of Aspirin (acetylsalicylic acid) along with Depakote (divalproex) leads to decreased activity. This is because of decreased binding as well as inhibition of pathways involved in the metabolism of Depakene. Similarly, administration of Carbapenems also leads to a decrease in the levels of Depakene ions and may lead to loss of seizure control.

Felbamate, on the other hand, lead to an increase of the level of valproate. Similarly, Rifater (rifampin, isoniazid and pyrazinamide) also leads to an increase in the levels of Valproate ions. Therefore, if Felbamate or rifampin is administered concomitantly with Depakote, then the dose of Depakote needs to be reduced to prevent overdosage.

These are some of the drugs that interact with Depakote. There are other drugs too. To avoid any complications due to drug interactions, you must consult with your doctor before beginning any therapy with Depakote.

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