Divalproex Sodium (Oral)

Overview

Divalproex sodium is an effective prescription medication used in the treatment of epileptic seizures, other more generalized seizures and convulsions, the manic phase associated with bipolar disorder, and in the prevention of migraine headaches. This medication is available as a delayed-release tablet or as sprinkles that can be added to soft foods such as applesauce and pudding. Divalproex sodium is only available with a prescription from your doctor.

This medication has caused overdoses in some instances and patients should familiarize themselves with the signs of overdose in order to seek immediate emergency care should they overdose. Due to this serious risk, patients need to adhere to the directions provided by their doctor and not take more than the prescribed amount; this drug should not be taken for a longer period of time than the prescribed course of treatment.

Patients that are pregnant or planning to become pregnant should not take this medication as it can cause serious harm to the fetus, especially in the first trimester. If you are taking this medication and are of childbearing age, be sure to utilize an effective contraceptive method during the entire course of treatment.

Divalproex sodium can cause serious damage to vital organs such as pancreas, kidneys, and liver; therefore all significant side effects should be immediately reported to your doctor.

Conditions Treated

  • Epilepsy
  • Seizure Disorders
  • Bipolar Disorder (Manic Phase)
  • Migraines

Type Of Medicine

  • Anticonvulsant

Side Effects

Many medications can cause unwanted side effects in addition to performing their desired and necessary system changes. Below is a list of a number of symptoms that require further medical advice should they occur. If you experience one or more of the listed side effects it is advised that you contact your doctor right away.

More Likely:

  • Stools that are black and tarry
  • Unusual weight gain or loss
  • Bloating or swelling of the face, arms, hands, lower legs, or feet
  • Unusual bleeding or bruising
  • Confusion
  • Trembling or shaking of the hands or feet
  • Crying
  • Tightness in the chest
  • Dementia
  • A sore throat
  • Diarrhea
  • Shivering
  • Dysphoria
  • A runny nose
  • Fever or chills
  • Rapid weight gain
  • Headaches
  • Pinpoint red spots on the skin
  • Loss of appetite
  • Painful or difficult urination
  • Mental depression
  • Nervousness
  • Nausea
  • Muscle aches and pains
  • Paranoia
  • Lower back or side pain
  • Quick to react or overreact emotionally
  • Joint pain
  • Rapidly changing moods
  • General feeling of discomfort or illness
  • Shakiness in the legs, arms, hands, or feet
  • Euphoria
  • Sleepiness or unusual drowsiness
  • Difficult or labored breathing
  • Sweating
  • Depersonalization
  • Tingling of the hands or feet
  • Delusions
  • Trouble sleeping
  • A cough or hoarseness
  • Unusual tiredness or weakness
  • Blood in the urine or stools
  • Vomiting
  • Bleeding gums

Less Likely:

  • Abnormal dreams
  • Vomiting of blood or material that looks like coffee grounds
  • Anxiety
  • Uncontrolled movements of the arms and legs
  • Blurred vision
  • Twitching
  • Itchiness
  • Swollen joints
  • Change in walking and balance
  • Small red or purple spots on the skin
  • Chest pain
  • Shakiness and unsteady walk
  • Cloudy urine
  • Restlessness
  • Cold sweats
  • Rapid or worm-like movements of the tongue
  • Dark urine
  • Pounding in the ears
  • Difficulty with moving
  • Pains in the stomach, side, or abdomen, possibly radiating to the back
  • Dizziness
  • Muscle tension or tightness
  • Lightheadedness when suddenly getting up from a lying or sitting position
  • Multiple swollen and inflamed skin lesions
  • Excessive muscle tone
  • Loss of bladder control
  • Leg cramps
  • Frequent urge to urinate
  • Lack of coordination
  • Hyperventilation
  • Feeling of warmth or heat
  • Indigestion
  • Increased need to urinate
  • Large, flat, blue or purplish patches on the skin
  • Heavy non-menstrual vaginal bleeding
  • Lip smacking or puckering
  • Flushing or redness of the skin, especially on the face and neck
  • Loss of strength or energy
  • Fast, irregular, pounding; racing heartbeat or pulse
  • Muscle pain or stiffness
  • Dry mouth
  • Normal menstrual bleeding occurring early; lasting longer than expected
  • Faintness
  • Passing urine more often
  • Dizziness
  • Puffing of the cheeks
  • Degenerative joint disease
  • Rapid weight gain
  • Constipation
  • Seeing, hearing, or feeling things that are not there
  • Clumsiness or unsteadiness
  • Slurred speech
  • Chills
  • Sweating
  • Changes in patterns and rhythms of speech
  • Trouble with speaking
  • Change in personality
  • Uncontrolled chewing movements
  • Bruising or burning of the skin
  • Unsteadiness, trembling, or other problems with muscle control or coordination
  • Bloody nose
  • Yellow eyes or skin
  • Absence of or decrease in body movement

Because it is possible to overdose on divalproex sodium, it is imperative that immediate emergency medical care is sought should you experience any of these overdose signs.

Overdose Symptoms:

  • Slow or irregular heartbeat
  • Fainting
  • Loss of consciousness
  • Change in consciousness

While the body is adjusting to the increase of divalproex sodium in the system, certain symptoms may occur that are generally unharmful and will dissipate on their own. If you experience one or more of the side effects listed below and it appears that they begin to worsen or they last for longer than a few days it is always best practice to consult with your prescribing physician for further instruction.

More Likely:

  • Acid or sour stomach
  • Lack or loss of strength
  • Weight gain
  • Body aches or pain
  • Uncontrolled eye movements
  • Congestion
  • Tender, swollen glands in the neck
  • Hair loss or thinning of the hair
  • Rash
  • Heartburn
  • Loss of memory
  • Problems with memory
  • Impaired vision
  • Seeing double
  • Hearing loss
  • Trouble with swallowing
  • Continuing ringing or buzzing in the ears
  • Voice changes
  • Change in vision
  • Weight loss
  • Unexplained noise in the ears
  • Belching

Less Likely:

  • Absent, missed, or irregular menstrual periods
  • Itching skin
  • Neck pain
  • Stopping of menstrual bleeding
  • Burning, dry, or itching eyes
  • Sneezing
  • Coin-shaped lesions on the skin
  • Redness, swelling, or soreness of the tongue
  • Cramps
  • Redness or swelling in the ear
  • Discharge or excessive tearing
  • Passing gas
  • Earache
  • Pain during sexual intercourse
  • Eye pain
  • Oily skin
  • Full feeling
  • Loss of bowel control
  • Increased appetite
  • Itching of the vagina or genital area
  • Heavy bleeding
  • Pain
  • Feeling of constant movement of self or surroundings
  • Pain or tenderness around the eyes and cheekbones
  • Excess air or gas in the stomach or intestines
  • Rash with flat lesions or small raised lesions on the skin
  • Dry skin
  • Redness, pain, swelling of the eye, eyelid, or inner lining of the eyelid
  • Dandruff
  • Sensation of spinning
  • A cough producing mucus
  • Stiff neck
  • Change in taste or bad, unusual or unpleasant aftertaste
  • Thick, white vaginal discharge with no odor or with a mild odor
  • Back pain

While the above lists are comprehensive, there is always the possibility that you will experience side effects that are not included on them. Should you have concerns about any reactions to your medication, or symptoms appear to worsen, it is advised that you consult with your physician or pharmacist for further medical advice.

Dosage

Divalproex sodium is only available with a prescription and should always be taken as directed by the prescribing physician. Many patients report that they experience an upset stomach when taking this medication which can be avoided by taking the tablets with food.

It is important to maintain a level amount of divalproex sodium in the system and to achieve this you must take the medication at the same time each day. Take the drug exactly as your doctor instructs, and do not take more of it or take it more often than prescribed. It is important that the entire course of treatment be taken, therefore, take all of the prescribed medication even if you begin to feel better and your symptoms improve.

If you have difficulty with swallowing pills and tablets, you may open the time-release capsules and sprinkle the drugs inside over soft food. Your doctor may also prescribe the sprinkle medications for you in such instances. If you take the drug in this manner, be sure to swallow it immediately and do not chew the applesauce or pudding to which you add it. Follow this dosage with a glass of water to make sure that the entire contents of the capsule has been consumed.

Do not ever crush or chew or otherwise alter any tablets or time-release capsules; always take this medication with an 8 oz. glass of water.

The gelatin that contains the time release sprinkles will likely pass through your system and you may notice the remains of the capsule in your stool. This is entirely natural and should not cause you any alarm.

If you experience any difficulty taking this medication or have questions relating to how often or how much you should be taking, it is important that you consult with your doctor or pharmacist immediately and ensure that you are taking the medication correctly.

These dosage guidelines for each of the three different delivery options and three different conditions that they treat are the typical amounts prescribed, however, you should always follow the instructions provided by your doctor. Should you have any questions, confer with your prescribing physician or pharmacist rather than take the medication incorrectly.

Regular or Delayed-Release Tablets (Oral Dosages)

This drug is typically used in patients who are adults or are children over the age of 10. If your young child (under the age of 10) is prescribed this medication, be sure to follow the instructions provided by their pediatrician or doctor.

Seizure Treatment

Your doctor will inform you of the dose which is based on your body weight. Typically, a small amount of 10mg - 15mg per body weight (in kilograms) is first introduced and then the dosage is increased each week by 5mg - 10mg per kilo as necessary. Typically, the prescribed dosages will not exceed 60mg per kilogram of body weight taken each day. If the patient is taking more than 250mg, their doctor will likely divide the dose into smaller amounts that are taken multiple times throughout the day.

Treatment of Migraines

The typical maximum dose is 250mg taken two times each day for a total of 500mg, with 1,000mg per day the likely upper threshold of this medication when taken for the treatment of migraines.

Mania (Associated with Bipolar Disorder) Treatment

Maximum doses are generally 60mg per each kilogram of body weight. Your doctor will likely start the dose at 750mg taken each day and divided into smaller amounts that are taken multiple times. The beginning dosage will be increased as necessary.

Extended-Release Capsules

This drug is typically used in patients who are adults or are children over the age of 10. If your young child (under the age of 10) is prescribed this medication, be sure to follow the instructions provided by their pediatrician or doctor.

Mania (Associated with Bipolar Disorder) Treatment

Your doctor will inform you of the dose which is based on your body weight. The dosage will likely start at 25mg per day for each kilogram of body weight. If necessary, your doctor may increase your dosage with 60mg per day being the maximum.

Treatment of Migraines

The maximum dosage is usually 1,000mg per day. Your doctor will likely start you at 500mg taken one time per day for one week. Following this time period, they will determine if the dosage needs to be increased.

Seizure Treatment

Your doctor will inform you of the dose which is based on your body weight. Typically, a small amount of 10mg - 15mg per body weight (in kilograms) is first introduced and then the dosage is increased each week by 5mg - 10mg per kilo as necessary. Typically, the prescribed dosages will not exceed 60mg per kilogram of body weight taken each day. If the patient is taking more than 250mg, their doctor will likely divide the dose into smaller amounts that are taken multiple times throughout the day.

Medicated Sprinkles that are Added to Soft Foods

This drug is typically used in patients who are adults or are children over the age of 10. If your young child (under the age of 10) is prescribed this medication, be sure to follow the instructions provided by their pediatrician or doctor.

Seizure Treatment

Your doctor will inform you of the dose which is based on your body weight. Typically, a small amount of 10mg - 15mg per body weight (in kilograms) is first introduced and then the dosage is increased each week by 5mg - 10mg per kilo as necessary. Typically, the prescribed dosages will not exceed 60mg of kilograms of body weight taken each day. If the patient is taking more than 250mg, their doctor will likely divide the dose into smaller amounts that are taken multiple times throughout the day.

Interactions

Divalproex sodium can react negatively when taken with other medications. If both drugs are necessary, your doctor may alter the dosage amount or the frequency with which you take the medications. It is important that you inform your doctor of all medications that you are currently taking, both prescription and non-prescription. They will also need to be aware of any over the counter medications that you may be taking along with all herbal remedies and vitamin and mineral supplements. If any of your medications change while you are taking divalproex sodium be sure to inform your doctor.

The use of divalproex sodium is not advised for patients that are currently taking any of the following; if your doctor does opt to prescribe both, be sure to alert them of any issues that you may experience, and follow their dosage instructions very carefully.

  • Vorinostat
  • Cisplatin
  • Primidone
  • Ertapenem
  • Meropenem
  • Lamotrigine
  • Warfarin
  • Calcifediol
  • Orlistat
  • Imipenem
  • Sodium Oxybate
  • Doripenem

The incidence of certain side effects may increase if you are currently taking any of the drugs listed below. Be sure to advise your doctor of any side effects or symptoms that you experience when taking both medications.

  • Acyclovir
  • Topiramate
  • Nimodipine
  • Betamipron
  • Ritonavir
  • Cholestyramine
  • Rifapentine
  • Erythromycin
  • Felbamate
  • Panipenem
  • Ginkgo
  • Olanzapine
  • Lorazepam
  • Phenytoin
  • Nortriptyline
  • Mefloquine
  • Oxcarbazepine
  • Lopinavir
  • Phenobarbital
  • Fosphenytoin
  • Rifampin
  • Ethosuximide
  • Risperidone
  • Clomipramine
  • Rufinamide
  • Carbamazepine
  • Valacyclovir
  • Aspirin
  • Zidovudine

If you experience any adverse effects while taking this medication it may be due to certain foods that you are consuming, or use of alcohol or tobacco. Be sure to inform your doctor of any changes that occur to your overall health and wellness when taking this drug as it may alter the effectiveness of the medication.

Other Medical Issues and Negative Interactions:

If you suffer from any of these conditions or ailments be sure to inform your doctor prior to beginning your course of treatment as there are negative interactions that are possible, and for patients with some conditions it is advised that the medication is avoided.

  • Mitochondrial disorders, including Alpers-Huttenlocher syndrome
  • Congenital metabolism disorders
  • Inflammation of the Pancreas (Pancreatitis)
  • Pregnant women who suffer from migraines are advised against using this medication
  • Mental retardation with severe seizure disorders
  • Depression
  • Mental illness
  • Liver Disease (including a history of the disease)
  • Low Platelet Count (Thrombocytopenia)
  • Urea cycle disorder (genetic disorder) are advised to avoid this drug

Warnings

This medication requires regular monitoring to ensure that it is performing in an effective manner and to monitor your system for any unwanted and potentially dangerous side effects. Your doctor may order blood tests or other diagnostic tests to safely and effectively manage your course of treatment.

Women should not take this medication while they are pregnant, especially during the first trimester. It is important to take effective birth control while taking this medication, and if you should become pregnant it is imperative that you notify your prescribing physician immediately.

Divalproex sodium can cause damage to the liver and also cause serious conditions that affect the organ. If you experience any signs of possible liver difficulty such as those listed below, notify your doctor immediately.

  • Abdominal or stomach pain or tenderness
  • Unusual tiredness or weakness
  • Dark urine
  • Skin rash
  • Fever
  • Loss of appetite
  • Itching
  • Swelling of the feet or lower legs
  • Nausea and vomiting
  • Headaches
  • Decreased appetite
  • Clay-colored stools
  • Yellow eyes or skin

Another serious condition, pancreatitis, may occur while you are using this medicine. It is important that you notify your physician immediately if you experience chills, constipation, nausea, vomiting, lightheadedness, severe stomach pain or fever. If the symptoms are severe, it is advised that you seek emergency medical attention.

Patients taking divalproex sodium may also experience a medical condition known as hyperammonemic encephalopathy, this condition can be quite serious, and your doctor should be immediately informed if you suffer from any of the following symptoms:

  • Unusual drowsiness
  • Dullness
  • Tiredness
  • Weakness or feelings of sluggishness
  • Changes in your mental status
  • Low body temperature
  • Vomiting

If you are going to partake in any activity, such as driving or operating heavy machinery, that requires complete alertness be sure that you know how divalproex sodium affects you. This medication has been reported to cause lightheadedness and dizziness, and also cause patients to feel tired and less alert than usual.

This medication should not be stopped abruptly as it may heighten the risk of seizures. If you want to stop taking divalproex sodium it is best to first check with your doctor who will help you to reduce your dosage on a safe schedule. This method will also help to lessen the chance of experiencing symptoms of withdrawal.

Divalproex sodium can alter the results of a number of medical and diagnostic tests, and your doctors should all be notified that you are currently taking this medication prior to you undergoing any type of medical testing.

Prior to beginning your treatment with divalproex sodium, and throughout your entire course of treatment, your doctor must be informed of all medications that you are taking as well as any changes to your overall health and wellness. Make sure that you include all non-prescription and over the counter medications as well as your prescription drugs. Your healthcare team will also need to know about all herbal remedies that you are taking as well as any vitamin and mineral supplements.

The effects of alcohol and any central nervous system (CNS) drugs will be heightened while you are taking divalproex sodium and should be avoided. If you are currently taking any over the counter medications that affect the CNS, such as antihistamines and medicines for colds and allergies, be sure to discuss such use with your doctor prior to beginning your course of treatment. CNS depressing drugs also include tranquilizers, sleep aids, barbiturates, muscle relaxers, and narcotic pain medications, all of which should be discussed with your prescribing physician.

The use of this medication has been known to cause serious and detrimental reactions to the liver, kidney, or other essential organs. This damage is related to an allergic reaction to divalproex sodium and is indicated by swollen lymph glands (in any of the following areas of the body: groin, armpit, or neck), yellow skin and/or eyes, headache, stomach pain, dark urine, and fever. If you experience any of these side effects it is important that you seek immediate emergency help or contact your doctor or 911.

Patients that are taking divalproex sodium have reported that it can make them display abnormal or antisocial behaviors. If you become irritable or agitated, feel severely depressed or have thoughts of suicide it is important that you inform your doctor of such effects right away.

Storage

It is always best to store all medications in their original packaging. Do not expose the medication to direct light, excessive heat or cold, and do not freeze. Keep the medication in a dry spot with very little moisture.

Keep this and all medications out of the reach of children.

If you have excess or unused medication or medication that is expired at the conclusion of your course of treatment, it is best to consult with your pharmacist about the most appropriate way to dispose of the drugs.

Summary

Divalproex sodium is an effective prescription medication used in the treatment of epileptic seizures, other more generalized seizures and convulsions, the manic phase associated with bipolar disorder, and in the prevention of migraine headaches. This medication is available as a delayed-release tablet or as sprinkles that can be added to soft foods such as applesauce and pudding. Divalproex sodium is only available with a prescription from your doctor.

This medication has caused overdoses in some instances and patients should familiarize themselves with the signs of overdose in order to seek immediate emergency care should they overdose. Due to this serious risk, patients need to adhere to the directions provided by their doctor and not take more than the prescribed amount; this drug should not be taken for a longer period of time than the prescribed course of treatment.

Your doctor will likely order blood or other diagnostic tests to manage the efficacy of this drug, and all appointments for such tests should be kept by the patient. Do not stop taking this drug without the direction of your doctor as you could possibly face dangerous withdrawal symptoms if you stop taking it in an abrupt manner.

There is the possibility of serious negative reactions to vital organs while taking divalproex sodium, therefore, patients should report all significant side effects to their physicians immediately.