- Brand Name : Depakote ER
- Drug Class : Anticonvulsants, Other
- Medical Author :
- Medical Reviewer :
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What Is Divalproex Sodium and How Does It Work?
Divalproex sodium is a stable coordination compound comprised of sodium valproate and valproic acid used to treat manic episodes associated with bipolar disorder, epilepsy, and migraine headaches.
- Divalproex sodium is available under the following different brand names: Depakote, Depakote ER, and Depakote Sprinkles.
What Are Dosages of Divalproex Sodium?
Dosages of Divalproex Sodium:
Dosage Forms and Strengths
Dosages expressed as valproic acid equivalents
Tablet, delayed-release (Depakote)
- 125mg
- 250mg
- 500mg
Tablet, extended-release (Depakote ER)
- 250mg
- 500mg
Capsule (Depakote Sprinkles)
- 125mg
Dosage Considerations – Should be Given as Follows: Mania
Indicated for the treatment of manic episodes associated with bipolar disorder
- Depakote initial dose: 750 mg/day orally in divided doses
- Depakote ER initial dose: 25 mg/kg orally once daily Increase as rapidly as possible to achieve the lowest therapeutic dose that provides desired clinical effect or plasma concentration
- Not to exceed 60 mg/kg/day
Epilepsy
- Complex partial seizures: Indicated as monotherapy and adjunctive therapy for complex partial seizures that occur either in isolation or in association with other types of seizures
- Simple and complex absence seizures: Also indicated for use as sole and adjunctive therapy in the treatment of simple and complex absence seizures, and adjunctively in patients with multiple seizure types that include absence seizures
Adult:
- 10-15 mg/kg/day orally initially; may increase by 5-10 mg/kg/week to achieve optimal clinical response; not to exceed 60 mg/kg/day
- Depakote: If a daily dose greater than 250 mg, give a divided dose
Pediatric:
- 10-15 mg/kg/day orally initially; may increase by 5-10 mg/kg/week to achieve optimal clinical response; not to exceed 60 mg/kg/day
- Children under 10 years: Safety and efficacy not established
Migraine Prophylaxis
Indicated for prophylaxis of migraine headaches; there is no evidence of use for acute treatment
- Depakote initial dose: 250 mg orally twice daily for 1 week
- Depakote ER initial dose: 500 mg orally once/day for 1 week
- May increase dose up to 1000 mg/day if needed
Dosage Modifications
Conversion to monotherapy: Decrease concomitant anti-epilepsy drug dosage approximately 25% every 2 weeks
Renal impairment
- No adjustment is necessary; protein binding is reduced and may cause measurement of total valproate concentrations to be inaccurate
Hepatic impairment
- Administer lower doses
- Contraindicated in severe impairment
Dosing Considerations
Monitor liver function tests (LFT’s)
Conversion from Depakote to Depakote ER:
- Administered Depakote ER once daily using a dose 8-20% higher than the total daily dose of Depakote
Therapeutic range
- Low serum albumin levels may cause an increase in unbound drugs (while total concentration may appear normal)
- Epilepsy: 50-100 mcg/mL total valproate
- Mania: 50-125 mcg/mL total valproate; maximum concentrations generally achieved within 14 days
Administration
- Swallow whole, do not chew or crush
- Capsules may be opened and sprinkled on a spoonful of soft food immediately before administration
- If a dose is skipped, do not double the next dose
Depakote or Depakote Sprinkles:
- If a daily dose greater than 250 mg, give a divided dose
Depakote ER:
- Administer once daily