Advertisement

Generic Name:

divalproex-sodium, Oral tablet

Generic Name:
Depakote,Depakote ER

divalproex-sodium, Oral tablet

All Brands

  • Depakote
  • Depakote ER
SECTION 1 of 4

Highlights for divalproex-sodium

Oral tablet
1

Divalproex sodium is an oral medication that’s used to treat certain types of seizures and manic episodes of bipolar disorder, and to prevent migraine headaches.

2

Your dose depends on the condition that’s being treated, your other health conditions, and your age.

3

This drug can cause serious liver damage that can be fatal, especially in children younger than 2 years. Your risk of serious liver damage may be higher during your first 6 months of treatment with this drug.

4

If you don’t take divalproex as prescribed, there can be serious risks. Don’t stop taking this drug without talking to your doctor first. Stopping this drug suddenly if you’re taking it for seizures can cause a seizure that won’t stop (status epilepticus). 

5

Divalproex sodium can cause drowsiness and dizziness. Don’t use alcohol while taking this drug because it can make these symptoms worse. Don’t drive a vehicle, use machinery, or do other activities that require alertness.

IMPORTANT INFORMATION

FDA warning

This drug has a Black Box Warning. This is the most serious warning from the Food and Drug Administration (FDA). A black box warning alerts doctors and patients to potentially dangerous effects.

  • Liver damage warning. This drug can cause serious liver damage that can be fatal, especially in children younger than 2 years old and anyone with hereditary neurometabolic syndrome. Your risk of serious liver damage may be higher during your first 6 months of treatment with this drug. In some cases, liver damage may continue even after you stop the drug. Your doctor will monitor you closely for symptoms and will check your liver function before starting and during treatment with divalproex sodium.
  • Birth defects warning. This drug may cause serious harm to your unborn baby. If you take this drug during pregnancy, your baby is at risk for serious birth defects. These include birth defects that affect the brain, spinal cord, heart, head, arms, legs, and the opening where urine comes out. These defects can happen in the first month of pregnancy, before you know you’re pregnant.
  • Pancreatitis warning. This drug can cause severe inflammation in your pancreas (pancreatitis). This condition can be fatal. This can happen shortly after you start treatment or several years after you have used the drug.

Risk of suicidal thoughts

This drug may cause suicidal thoughts or actions in a small number of people, about 1 in 500. Your risk may be higher if you already have a mood disorder, such as depression or anxiety. Call your doctor 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 or violent or being angry
  • acting on dangerous impulses
  • an extreme increase in activity and talking (mania)
  • other unusual changes in behavior or mood

Allergic reaction

This drug can cause a severe allergic reaction (hypersensitivity). Call your doctor if you have the following symptoms. If symptoms are severe or life threatening, seek immediate medical attention first.

  • trouble swallowing or breathing
  • swelling of your throat, tongue, eyes, or lips
  • hives or skin rash
  • sores in your mouth
  • blistering and peeling of your skin
  • swelling of your lymph nodes

What is divalproex sodium?

This drug is a prescription drug. It’s available in these forms: oral delayed-release tablets, oral extended-release tablets, and oral sprinkle capsules.

This drug is available in its generic form. Generic drugs usually cost less. In some cases they may not be available in every strength or form as the brand. Talk to your healthcare provider to see if the generic will work for you.

This drug may be used as part of a combination therapy. That means you need to take it with other drugs.

Why it's used

This drug is used alone or with other medications to treat:

  • complex partial seizures that occur by themselves or in association with other types of seizures. 
  • simple and complex absence seizures. 
  • multiple seizure types that include absence seizures.  

More Details

How it works

This drug belongs to a class of drugs called anti-epileptics. A class of drugs refers to medications that work similarly. They have a similar chemical structure and are often used to treat similar conditions.

This drug works by increasing brain concentrations of a certain chemical, GABA, which reduces the excitability of your nervous system. This helps to treat seizures and manic episodes and prevent migraines.

Why it's used

This drug is used alone or with other medications to treat:

  • complex partial seizures that occur by themselves or in association with other types of seizures. 
  • simple and complex absence seizures. 
  • multiple seizure types that include absence seizures. 

This drug is used to treat the manic phase of bipolar disorder (a manic-depressive illness). A manic episode is a period of time where your mood is extremely strong. This may include an elevated or an irritated mood.

This drug is used to prevent migraine headaches. There is no evidence that it works to treat a migraine headache when you already have one. 

Advertisement
SECTION 2 of 4

divalproex-sodium Side Effects

Oral tablet

Most Common Side Effects

The most common side effects that occur with divalproex sodium include:

  • nausea

  • headache

  • sleepiness

  • vomiting

  • weakness

  • tremor

  • dizziness

  • stomach pain

  • blurry or double vision

  • diarrhea

  • increased appetite or loss of appetite

  • weight gain

  • hair loss

  • problems with walking or coordination

If these effects are mild, they may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk to your doctor or pharmacist.

Serious Side Effects

If you experience any of these serious side effects, call your doctor right away. If your symptoms are potentially life threatening, or if you think you’re experiencing a medical emergency, call 9-1-1.

  • bleeding problems. Symptoms may include:

    • red or purple spots on your skin
    • bruising more easily than normal
    • bleeding from your mouth or nose
  •  high ammonia levels in your blood. Symptoms may include:

    • feeling tired
    • vomiting
    • confusion
  •  low body temperature (hypothermia). Symptoms may include:

    • drop in your body temperature to less than 95°F
    • tiredness
    • confusion
    • coma
    • slow, shallow breathing
    • weak pulse
    • slurred speech
  •  allergic (hypersensitivity) reactions. Symptoms may include:

    • 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
  • multiorgan hypersensitivity reactions. Symptoms may include:

    • fever
    • rash
    • swollen lymph nodes
    • pain and swelling around major organs, such as the liver, kidneys, heart, or muscles
  • drowsiness or sleepiness

  • pancreatitis. Symptoms may include:

    • nausea
    • vomiting
    • severe abdominal pain
    • loss of appetite
Pharmacist's Advice
Clinical Associate Professor, University of Illinois at Chicago College of Pharmacy

This drug can cause drowsiness and dizziness.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this information includes all possible side effects. This information is not a substitute for medical advice. Always discuss possible side effects with a healthcare provider who knows your medical history.
SECTION 3 of 4

divalproex-sodium May Interact with Other Medications

Oral tablet

Divalproex sodium can interact with other medications, herbs, or vitamins you might be taking. That’s why your doctor should manage all of your medications carefully. If you’re curious about how this drug might interact with something else you’re taking, talk to your doctor or pharmacist.

Note: You can reduce your chances of drug interactions by having all of your prescriptions filled at the same pharmacy. That way, a pharmacist can check for possible drug interactions.

Alcohol interaction

Divalproex sodium can cause drowsiness and dizziness. Don’t drink alcohol while taking this drug, because it has depressive effects and can increase your risks for slowed reflexes, poor judgment, and sleepiness.

Medications that might interact with this drug

Aspirin

This drug may increase the level of divalproex sodium in your body and increase your risk of side effects. Your doctor may adjust your dose of divalproex sodium.

Felbamate

This drug may increase the level of divalproex sodium in your body and increase your risk of side effects. Your doctor may adjust your dose of divalproex sodium.

Tuberculosis drugs
  • rifampin

This drug may decrease the level of divalproex sodium in your body. This means that it may not work as well to treat your condition. Your doctor may adjust your dose of divalproex sodium.

Carbapenem antibiotics
  • ertapenem
  • imipenem
  • meropenem

These drugs may decrease the level of divalproex sodium in your body. This means that it may not work as well to treat your condition. If you have to take one of these antibiotics while on this drug, your doctor will monitor your blood levels closely.

Mood disorder and seizure drugs
  • amitriptyline/nortriptyline
  • diazepam
  • ethosuximide
  • lamotrigine
  • phenobarbital
  • primidone
  • phenytoin
  • rufinamide

Divalproex sodium may increase the levels of these drugs in your body. Your doctor may adjust the dose of these medications or monitor you more closely for side effects.

Topiramate

Taking these drugs together may increase your risk of high ammonia levels in your blood or low body temperature (hypothermia). If you’re taking these drugs together, your doctor should monitor your blood ammonia levels and temperature. 

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs interact differently in each person, we cannot guarantee that this information includes all possible interactions. This information is not a substitute for medical advice. Always speak with your healthcare provider about possible interactions with all prescription drugs, vitamins, herbs and supplements, and over-the-counter drugs that you are taking.
Drug warnings
liver disease
People with liver disease

If you have a history of liver disease, you may have a higher risk of liver failure within the first 6 months of treatment with this drug. Your doctor will monitor you for signs of liver damage.

mitochondrial disease
People with mitochondrial disease

If you personally have or have a family history of Alpers-Huttenlocher syndrome, a type of metabolic disorder, you may have a higher risk of liver failure when taking divalproex sodium.

urea cycle disorder
People with urea cycle disorders

If you have a urea cycle disorder, you shouldn’t take this drug. It may raise your risk of high ammonia levels in your blood (hyperammonemia). It may even be fatal.

pregnant women
Pregnant women

This drug may cause serious harm to your unborn baby. If you take this drug during pregnancy, your baby is at risk for serious birth defects. These include birth defects that affect the brain, spinal cord, heart, head, arms, legs, and the opening where urine comes out. These defects can happen in the first month of pregnancy, before you know you’re pregnant.

If you become pregnant while taking this drug, talk to your doctor about registering with the North American Antiepileptic Drug Pregnancy Registry. The purpose of this registry is to collect information about the safety of drugs used to treat seizures during pregnancy.

For the treatment of seizures and manic episodes of bipolar disorder:

Divalproex sodium is a category D pregnancy drug. That means two things:

  1. Studies show a risk of adverse effects to the fetus when the mother takes the drug.
  2. The benefits of taking the drug during pregnancy may outweigh the potential risks in certain cases.

Tell your doctor if you’re pregnant or plan to become pregnant. Divalproex sodium should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

For the prevention of migraine headaches:

Divalproex sodium is a category X pregnancy drug. Category X drugs should never be used during pregnancy.

breastfeeding
Women who are breast-feeding

This drug passes through breast milk and can cause serious effects in a breastfeeding child.

You and your doctor may need to decide if you’ll take divalproex sodium or breastfeed.

for seniors
For seniors

Your body processes divalproex sodium more slowly. You may also experience more of a sedative effect from this medication. Extreme drowsiness may cause you to eat or drink less than you normally would. Tell your doctor if this happens.

Your doctor will monitor how much you eat and drink and check you for signs of dehydration, drowsiness, dizziness, and other side effects. They may stop giving you the drug if you aren’t eating or drinking enough or if you have extreme sleepiness. 

for children
For children

Children younger than 2 years old have an increased risk of liver damage while taking this drug, especially if they also take other drugs to treat seizures.

call doctor
When to call the doctor

Call your doctor if you have any sudden changes in mood, behaviors, thoughts, or feelings that may lead to suicidal thoughts or actions.

allergies
Allergies

This drug can cause a severe allergic reaction (hypersensitivity). Symptoms may include:

  • trouble swallowing or breathing
  • swelling of your throat, tongue, eyes, or lips
  • hives or skin rash
  • sores in your mouth
  • blistering and peeling of your skin
  • swelling of your lymph nodes

Don’t take this drug if you’ve ever had an allergic reaction to it. Taking it again could be fatal.

SECTION 4 of 4

How to Take divalproex-sodium (Dosage)

Oral tablet

All possible dosages and forms may not be included here. Your dose, form, and how often you take it will depend on:

  • your age
  • the condition being treated
  • how severe your condition is
  • other medical conditions you have
  • how you react to the first dose

What are you taking this medication for?

Seizures

Brand: Depakote

Form: Oral tablet delayed release
Strengths: 125 mg, 250 mg and 500 mg

Brand: Depakote ER

Form: Oral tablet extended release
Strengths: 250 mg and 500 mg

Brand: Depakote Sprinkles

Form: Oral capsule
Strengths: 125 mg
Adult dosage (ages 18-64 years)
  • Complex partial seizures:
    • First dose: 10–15 mg/kg taken by mouth once per day if you’re taking extended-release tablets. For sprinkle capsules and delayed-release tablets, the dosage is 2–3 times per day.
    • Dose adjustment: increase at 1-week intervals by 5–10  mg/kg per day.
    • Maximum dose: 60 mg/kg per day
  • Absence seizures:
    • First dose: 15 mg/kg taken by mouth once per day if you’re taking extended-release tablets. For sprinkle capsules and delayed-release tablets, the dosage is 2–3 times per day.
    • Dose adjustment: increase at 1-week intervals by 5–10  mg/kg per day.
    • Maximum dose: 60 mg/kg per day
Child dosage (ages 10-17 years)
  • Complex partial seizures:
    • First dose: 10–15 mg/kg taken by mouth once per day if you’re taking extended-release tablets. For sprinkle capsules and delayed-release tablets, the dosage is 2–3 times per day.
    • Dose adjustment: increase at 1-week intervals by 5–10  mg/kg per day.
    • Maximum dose: 60 mg/kg per day
  • Absence seizures:
    • First dose: 15 mg/kg taken by mouth once per day if you’re taking extended-release tablets. For sprinkle capsules and delayed-release tablets, the dosage is 2–3 times per day.
    • Dose adjustment: increase at 1-week intervals by 5–10  mg/kg per day.
    • Maximum dose: 60 mg/kg per day
Child dosage (ages 0-9 years)

This medicine hasn’t been studied in children and shouldn’t be used in children younger than 10 years old.

Senior dosage (ages 65 years and older)

Your body  may process this drug more slowly and you may have more of a sedative effect. Your doctor may start you on a lowered dose and increase your dose slowly so that too much of this drug doesn’t build up in your body. Too much of the drug in your body can be toxic. 

In general, your doctor will keep you at the lowest effective dose that you’re able to tolerate without side effects.

Special considerations

Liver disease: If you have liver disease, you may not be able to process this drug as well as you should. Your doctor may start you at a lower dose to prevent toxic levels in your body and side effects.

Warnings

Divalproex sodium hasn’t been studied for long-term use in mania (longer than 3 weeks). If your doctor would like you to take this drug for a longer period of time, they will check if you still need the drug regularly.

Bipolar disorder

Brand: Depakote

Form: Oral tablet delayed release
Strengths: 125 mg, 250 mg and 500 mg

Brand: Depakote ER

Form: Oral tablet extended release
Strengths: 250 mg and 500 mg

Brand: Depakote Sprinkles

Form: Oral capsule
Strengths: 125 mg
Adult dosage (ages 18-64 years)

Delayed-release tablet:

  • Mania:
    • First dose: 375 mg taken by mouth twice per day or 250 mg three times per day
    • Dose adjustment: increase as quickly as possible until it’s effective or until a desired blood level is reached.
    • Maximum dose: 60 mg/kg per day

Extended-release tablet:

  • Mania:
    • First dose: 25 mg/kg taken by mouth once per day.
    • Dose adjustment: increase as quickly as possible until it’s effective or until a desired blood level is reached.
    • Maximum dose: 60 mg/kg per day
Child dosage (ages 0-17 years)

This medicine hasn’t been studied in children and shouldn’t be used in people younger than18 years old.

Senior dosage (ages 65 years and older)

Your body  may process this drug more slowly and you may have more of a sedative effect. Your doctor may start you on a lowered dose and increase your dose slowly so that too much of this drug doesn’t build up in your body. Too much of the drug in your body can be toxic. 

In general, your doctor will keep you at the lowest effective dose that you’re able to tolerate without side effects.

Special considerations

Liver disease: If you have liver disease, you may not be able to process this drug as well as you should. Your doctor may start you at a lower dose to prevent toxic levels in your body and side effects.

Warnings

Divalproex sodium hasn’t been studied for long-term use in mania (longer than 3 weeks). If your doctor would like you to take this drug for a longer period of time, they will check if you still need the drug regularly.

Migraine prevention

Brand: Depakote

Form: Oral tablet delayed release
Strengths: 125 mg, 250 mg and 500 mg

Brand: Depakote ER

Form: Oral tablet extended release
Strengths: 250 mg and 500 mg

Brand: Depakote Sprinkles

Form: Oral capsule
Strengths: 125 mg
Adult dosage (ages 18-64 years)

Delayed-release tablet:

  • First dose: 250 mg taken by mouth twice per day
  • Dose adjustment: increase as needed.
  • Maximum dose: 1000 mg per day

Extended-release tablet:

  • First dose: 500 mg taken by mouth once per day
  • Dose adjustment: increase as needed.
  • Maximum dose: 1000 mg per day
Child dosage (ages 16-17 years)

Delayed-release tablet:

  • First dose: 250 mg taken by mouth two times per day
  • Dose adjustment: increase as needed.
  • Maximum dose: 1000 mg per day

Extended-release tablet:

  • First dose: 500 mg taken by mouth once per day
  • Dose adjustment: increase as needed.
  • Maximum dose: 1000 mg per day
Child dosage (ages 0-15 years)

This medicine hasn’t been studied in children and shouldn’t be used in people younger than 16 years old.  

Senior dosage (ages 65 years and older)

Your body  may process this drug more slowly and you may have more of a sedative effect. Your doctor may start you on a lowered dose and increase your dose slowly so that too much of this drug doesn’t build up in your body. Too much of the drug in your body can be toxic. 

In general, your doctor will keep you at the lowest effective dose that you’re able to tolerate without side effects.

Special considerations

Liver disease: If you have liver disease, you may not be able to process this drug as well as you should. Your doctor may start you at a lower dose to prevent toxic levels in your body and side effects.

 Warnings

Divalproex sodium hasn’t been studied for long-term use in mania (longer than 3 weeks). If your doctor would like you to take this drug for a longer period of time, they will check if you still need the drug regularly.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this list includes all possible dosages. This information is not a substitute for medical advice. Always to speak with your doctor or pharmacist about dosages that are right for you.
Pharmacist's Advice
Clinical Associate Professor, University of Illinois at Chicago College of Pharmacy

This drug comes with serious risks if you don't take it as prescribed.

If you don’t take it at all or miss doses

If you don’t take this drug regularly, miss doses, or stop it suddenly there can be serious risks. The condition that you’re trying to treat may not get better. You may also experience more side effects from this drug if you take it on and off.

If you stop taking it suddenly

If you’re taking this drug to treat seizures, stopping it suddenly can cause a seizure that won’t stop (status epilepticus).

If you take too much

If you take too much of this drug, call your doctor or local poison control center right away. If the side effects are severe or life threatening, call 9-1-1 or go to an emergency room. Symptoms may include:

  • extreme fatigue
  • irregular heart rate and rhythm
  • high levels of salt in your blood
  • deep coma
  • death

What to do if you miss a dose

If you forget to take your dose of this drug, take it as soon as you remember. If it’s just a few hours until the time for your next dose, wait and take only one dose at that time.

Never try to catch up by taking two doses at once. This could cause toxic side effects.

How to tell If the drug is working

To treat seizures: If this drug is working, your seizure control will improve.

To treat manic episodes of bipolar disorder: If this drug is working, you’ll see a decrease in symptoms caused by the manic phase of bipolar disorder. Your mood will be well controlled.

To prevent migraine headaches: If this drug is working, you’ll have fewer migraines.

This drug is a long-term drug treatment.

For manic episodes of bipolar disorder, your doctor will decide whether this is a short-term or long-term drug treatment.

Important considerations for taking this drug

Don't crush or chew the tablets

This drug sprinkle capsules may be swallowed whole. Or you may carefully open the capsule and sprinkle the entire contents on a small amount (teaspoon) of soft food such as applesauce or pudding. Swallow this mixture right away (avoid chewing). Don’t store it for future use.

Storage depends on the type you're using

Store delayed release tablets below 86°F (30°C).

Store extended-release tablets from 59–86°F (15–30°C).

Store sprinkle capsules below 77°F (25°C).

Keep this drug and all medicines out of the reach of children.

Keep your drugs away from areas where they could get wet, such as bathrooms. Store this drug away from moisture and damp locations.

Travel

When traveling with your medication:

  • Always carry your medication with you or in your carry-on bag.
  • Don’t worry about airport X-ray machines. They can’t hurt this medication.
  • You may need to show your pharmacy’s label to clearly identify the medication. Keep the original prescription label with you when traveling with your medication.
  • Don’t leave this medicine in the car, especially when the temperature is hot or freezing.

Clinical monitoring

Before starting and during treatment with this drug, your doctor may check the following:

  • drug plasma levels. Your doctor may test the levels of the drug in your body if you’re having side effects or to decide if you need a dose adjustment.
  • liver function tests
  • body temperature
  • signs of pancreatitis
  • signs of suicidal thoughts or actions
  • complete blood count
  • ammonia level

Are there any alternatives?

There are other drugs available to treat your condition. Some may be more suitable for you than others. Talk to your doctor about possible alternatives.


Show Sources

Content developed in collaboration with University of Illinois-Chicago, Drug Information Group

Medically reviewed by Creighton University, Center for Drug Information and Evidence-Based Practice on March 24, 2016

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up-to-date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.
Advertisement
Advertisement
Advertisement