Divalproex

Indications
 Oral
Primary generalised seizures
Adult: Initially, 10-15 mg/kg/day in 2-4 divided doses, if necessary, increase at 5-10 mg/kg/wk. Max: 60 mg/kg/day.
Child: ≥10 yr: Initially, 10-15 mg/kg/day in 2-4 divided doses, if necessary, increase at 5-10 mg/kg/wk. Max: 60 mg/kg/day.
Oral
Partial seizures
Adult: Initially, 10-15 mg/kg/day in 2-4 divided doses, if necessary, increase at 5-10 mg/kg/wk. Max: 60 mg/kg/day.
Child: ≥10 yr: Initially, 10-15 mg/kg/day in 2-4 divided doses, if necessary, increase at 5-10 mg/kg/wk. Max: 60 mg/kg/day.
Oral
Acute manic episodes of bipolar disorder
Adult: Initially, 25 mg/kg once daily, may increase rapidly to achieve optimal response at the lowest therapeutic dose. Max: 60 mg/kg/day.
Oral
Prophylaxis of migraine
Adult: 500 mg once daily for 1 wk, may increase to 1000 mg once daily.
Contraindications
 Hepatic disease or severe hepatic impairment; porphyria. Pregnancy.
Warnings / Precautions
 Children <2 yr; congenital metabolic disorders; organic brain disease or severe seizure disorders; HIV infection; renal impairment; lactation. Monitor liver function before and during the 1st 6 mth of therapy. Monitor platelet function, signs of pancreatitis and SLE. Gradual withdrawal of valproate. May impair ability to drive or operate machinery. Increased risk of hyperammonaemic encephalopathy in patients with urea cycle disorders.
Adverse Reactions
 Behavioural/mood changes; hyperammonaemia; pancreatitis, thrombocytopenia. Abdominal cramps, anorexia, diarrhoea, hair loss, indigestion, nausea and vomiting; tremor; unusual weight loss or gain.
Potentially Fatal: Hepatic failure, pancreatitis.
Drug Interactions
 Felbamate increases valproate levels. Phenytoin, phenobarbitone and carbamazepine lower valproate levels. Increased risk of hepatotoxity with hepatotoxic drugs.
Potentially Fatal: Potentiates action of CNS depressants (barbiturates, primidone) and alcohol.
See Below for More divalproex sodium Drug Interactions
Lab Interactions
 False positive result for urine ketones. May alter the results of thyroid function tests.
Food Interactions
 Food may delay the extent of absorption. Divalproex may cause GI upset; take with large amount of water of food to decrease GI upset.
Mechanism of Actions
 Divalproex sodium dissociates to the valproate ion in the GI tract. It is thought to work by increasing brain concentrations of GABA which may also play an important role in the prevention of migraine attacks.
Distribution: Plasma protein binding ranges from 10-18.5%.
Metabolism: Almost entirely by liver.
Administration
 Should be taken with food.
Storage Conditions
 Oral: Store at 15-30°C.
Storage
 Oral: Store at 15-30°C.
Available As
  • Divalproex Sodium 1 gm
  • Divalproex Sodium 1000 mg
  • Divalproex 1000 mg
  • Divalproex 125 mg
  • Divalproex Sodium 125 mg
  • Divalproex Sodium 200 mg
  • Divalproex Sodium 250 mg
  • Divalproex 250 mg
  • Divalproex Sodium 300 mg
  • Divalproex Sodium 500 mg
  • Divalproex 500 mg
  • Divalproex Sodium 750 mg
  • Divalproex 750 mg

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