Monograph Details
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Central Nervous System
> Seizure disorders
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DEPAKOTE |
| Manufacturer |
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Abbott Laboratories |
| Legal Classification |
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Rx
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| Generic Name |
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Divalproex sodium 125mg, 250mg, 500mg; delayed-release tabs. |
| Also |
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• DEPAKOTE ER
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| Indications |
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Absence seizures. Complex partial seizures. |
| Adults and Children |
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May swallow caps whole or sprinkle contents on soft food. <10yrs: not recommended. ≥10yrs: Absence seizures: initially 15mg/kg per day. Complex partial: initially 10–15mg/kg per day. Both: Give in 2–3 divided doses if total daily dose >250mg. Increase weekly if needed by 5–10mg/kg per day; max 60mg/kg per day. |
| Contraindications |
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Hepatic disease. Significant hepatic dysfunction. Urea cycle disorders. |
| Precautions |
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Discontinue if hepatic dysfunction, pancreatitis, thrombocytopenia, or hyperammonemic encephalopathy occurs. History of liver disease. Increased hepatotoxicity risk with congenital metabolic disorders, multiple AEDs, severe seizure disorders with mental retardation, organic brain disorders, in children <2 years of age. Monitor liver function and symptoms (esp. 1st 6 months). Follow-up if symptoms of hyperammonemia occur. Suicidal tendencies (monitor). Depakote ER is not bioequivalent to delayed-release tabs on mg/mg basis. Avoid abrupt cessation. Monitor platelets, bleeding time (at baseline, before surgery, and in pregnancy); reevaluate periodically. May affect HIV or CMV viral load (in vitro). Elderly (monitor fluid and nutritional intake, and for somnolence). Pregnancy (Cat.D): apprise females of childbearing potential of risks to fetus (eg, neural tube defects). Nursing mothers: not recommended. |
| Interactions |
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Monitor levels of valproate, ethosuximide, other anticonvulsants, and whenever an enzyme inducer is added or withdrawn. Potentiates carbamazepine, diazepam, ethosuximide, lamotrigine, phenobarbital, phenytoin, tolbutamide, warfarin, zidovudine, amitriptyline, nortriptyline. Potentiated by aspirin, felbamate. Levels reduced by rifampin, phenytoin, carbamazepine, phenobarbital. CNS depression with alcohol, other CNS depressants. Clonazepam may induce absence status in patients with history of absence seizures. May interfere with urine ketone and thyroid tests. Others: see literature. |
| Adverse Reactions |
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Dizziness, headache, GI upset; dermatologic, CNS (esp. tremor, somnolence), and endocrine effects; weakness, blood dyscrasias, bone marrow suppression, hepatotoxicity, acute pancreatitis, thrombocytopenia, hyperammonemia, metabolic abnormalities, others. |
| How Supplied |
Tabs 125mg—100
Tabs 250mg, 500mg—100, 500
Sprinkle caps—100
ER 250mg—60
ER 250mg, 500mg—100, 500 |
| Additional Resources |
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• Related Prescribing Note |
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