Depakote (Divalproex)

DEPAKOTE Withdrawal

Do not stop taking DEPAKOTE without talking to your healthcare provider first. Stopping a seizure medication like DEPAKOTE suddenly can cause serious withdrawal symptoms or other problems.  In a patient who has epilepsy, quitting abruptly can cause seizures that will not stop (status epilepticus).

DEPAKOTE Overdose

If you miss a dose, take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose.  Do not "double up" on this medication to make up for a missed dose.

Because one of the risks of this drug is an increase in the chance of liver damage, you should be on the lookout for these symptoms:

• Nausea
• Vomiting that does not go away
• Loss of appetite
• Pain the in the right side of your stomach
• Dark urine
• Swelling of your face, hands, arms, feet, and legs
• Yellowing of your skin or eyes (jaundice)

 DEPAKOTE can cause suicidal thoughts or actions. Call your doctor right away if you have any of these symptoms, especially if they are new:

• Thoughts of suicide or dying
• Attempts to commit suicide
• A depression that is new or getting worse
• Anxiety that is new or getting worse
• Feeling agitated or restless
• Panic attacks
• Trouble sleeping (insomnia)

This drug may cause life-threatening pancreatitis. Get emergency attention if you develop:

• Nausea
• Vomiting
• Abdominal pain, especially pain that radiates to the back or that feels worse after eating
• Tenderness when pressing on the stomach

Encephalopathy, a severe (sometimes fatal) brain disorder is a rare but possible side effect of this drug, especially in patients with certain metabolic disorders (urea cycle disorders).

Tell your doctor immediately if you develop unexplained weakness, vomiting, or sudden mental/mood changes like confusion.

Nausea is quite common when taking this medication. Between 10 and 20 percent of people who take DEPAKOTE report being nauseous at some point.

Common side effects of DEPAKOTE include:

• Diarrhea
• Dizziness
• Blurred or double vision
• Memory impairment
• Ringing in the ears
• Shakiness or unsteadiness (tremors)
• Somnolence (excessive sleepiness)
• Hair loss
• Irregular or painful menstrual periods
• Weight gain

Serious side effects of DEPAKOTE include:

• Chest pain
• Easy bruising or unexplained bleeding
• Irregular heartbeat
• Swelling of hands or deet
• Nystagmus (involuntary eye movement)
• Feeling cold or shivering
• Rapid breathing or loss of consciousness

Seek immediate medical attention if you develop signs of a serious allergic reaction to this medication:

• Rash
• Itching
• Swelling (especially in the face, tongue, or throat)
• Severe dizziness
• Trouble breathing

The FDA requires DEPAKOTE to carry a black-box warning because it can cause serious liver damage that could be fatal, especially in children younger than 2.  The risk of this happening is higher in the first six months of taking the drug. In some cases liver damage continued even after patients stopped taking DEPAKOTE .

There is an additional black-box warning linking DEPAKOTE to cases of life-threating pancreatitis.  In some cases, patients who developed pancreatitis rapidly went from initial symptoms to death, so getting medical treatment quickly is essential.

If you develop abdominal pain, nausea, vomiting, and a stomach that is tender to the touch, call 911 immediately.

Pancreatitis was reported in people who took this drug for a short time as well as in those who took it for years.

You should not take DEPAKOTE if you have a history of liver disease, a urea cycle disorder, or a genetic disorder such as Alpers' disease (a progressive degenerative disease of the central nervous system that occurs mostly in infants and children), or Alpers-Huttenlocher syndrome (the formal name for Alper's Disease).

DEPAKOTE and Pregnancy

The FDA warns DEPAKOTE can harm an unborn baby. Women who take this medication while pregnant could give birth to a child with serious birth defects.  The most common are those that affect the brain and spinal cord, particularly spina bifida or neural tube defects. These defects occur in one or two babies out of 100 that are exposed to DEPAKOTE before birth. Unfortunately, these defects can develop in the very first month of pregnancy, before you even know you are pregnant.

Studies also show if you take DEPAKOTE during pregnancy, your child is at risk for having a lower IQ. The FDA warns that women who take this drug should use effective birth control to prevent pregnancy. DEPAKOTE passes into breast milk. There have not been reports of harm to breastfeeding infants, but talk to your doctor about any risks to your child before you begin breastfeeding.

Drinking alcohol could increase nervous system side effects of DEPAKOTE like drowsiness, dizziness, difficulty concentrating, and impaired judgment.

Avoid alcohol altogether or limit how much you drink while taking this medication.

DEPAKOTE and Drug Interactions

The following drugs could interact moderately with DEPAKOTE:

• Carbamazepine (Tegretol)
• Salicylates (Doans Pills)
• Topiramate (Topamax and Topamax Sprinkle)
• Rifampin (Rifadin)
• Warfarin (Coumadn)
• Amitriptyline (Elavil)
• Clomipramine (Anafranil)
• Nortriptyline (Pamelor)
• Rufinamide (Banzel)
• Lorazepam (Ativan)
• Felbamate (Felbatol)

In addition, certain anticonvulsants, barbiturates, and hydantoins could interact with DEPAKOTE.

In some cases, the effect of a barbiturate could increase to toxic levels while the potency of DEPAKOTE could decrease, making the medicine ineffective.

You should always tell your healthcare professional about all prescription, non-prescription, over-the-counter, illegal and recreational drugs, herbal remedies, nutritional and dietary supplements, and any other drugs and treatments you are taking.