Divalproex

The recommended adult dose of divalproex to treat seizures is based on weight and the final dose is determined by control of seizures with minimal side effects. The recommended initial dosage is 15 mg per kg of body weight per day. Your doctor may then suggest increasing at one-week intervals by 5 to 10 mg per kg of body weight per day until seizures are controlled or side effects prevent further increases. The maximum recommended dosage is 60 mg per kg of body weight per day.

When taken to treat manic episodes, the starting dose is 250 mg 3 times daily.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

When the dose of divalproex increases above 250 mg per day, it should be taken in divided doses.

The tablets should be swallowed whole and can be taken with or without food. Divalproex should not be stopped suddenly due to the possibility of a rebound major seizure.

It is important to take Divalproex exactly as prescribed by your doctor. If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store Divalproex at room temperature, protect it from light and moisture, and keep it out of the reach of children.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

In addition to its desired action, this medication may cause some adverse effects, notably: it may cause hair loss; it may cause diarrhea; it may cause dizziness - use caution when getting up from a lying or sitting position and use caution if driving; it may cause unusual tiredness; it may cause nausea or, rarely, vomiting; it may cause shakiness. Each person may react differently to a treatment. If you think this medication may be causing adverse effects (including those described here, or others), talk to your health care professional. He or she can help you to determine whether or not the medication is the source of the problem.

Divalproex by Pro Doc is no longer being manufactured for sale in Canada. For brands that may still be available, search under "divalproex". This article is being kept available for reference purposes only. If you are using Divalproex, speak with your doctor or pharmacist for information about your treatment options.

Do not take divalproex if you:

• are allergic to Valproic acid, divalproex, or any ingredients of the medication
• have been diagnosed with a urea cycle disorder
• have liver disease or a significant reduction in liver function
• have Alpers syndrome or Alpers-Huttenlocher syndrome, conditions caused by nervous system breakdown
• have porphyria
• are pregnant and are taking Divalproex for Epilepsy unless there is no suitable alternative for seizure management
• are pregnant and are taking this mediation for bipolar disorder
• are a woman of child-bearing age and cannot follow the recommended birth control measures

There may be an interaction between divalproex and any of the following:

• Acarbose
• Acetazolamide
• alcohol
• antipsychotic medications (e.g., Chlorpromazine, Haloperidol, Olanzapine, Perphenazine, Risperidone)
• Asa (acetylsalicylic acid)
• barbiturates (e.g., butalbital, pentobarbital, Phenobarbital)
• benzodiazepines (e.g., Clonazepam, Diazepam, Lorazepam)
• birth control pills (estrogens)
• Bismuth Subsalicylate
• cannabis
• Carbamazepine
• Cholestyramine
• Cimetidine
• ertapenem
• Guanfacine
• HIV protease inhibitors (e.g., atazanavir, indinavir, ritonavir, saquinavir)
• imipenem
• Irinotecan
• isoniazid
• Lamotrigine
• lomustine
• macrolide antibiotics (e.g., clarithromycin, erythromycin)
• Mefloquine
• Minoxidil
• monoamine oxidase inhibitors (M.O.S. e.g., Moclobemide, Phenelzine, Rasagiline, Selegiline, Tranylcypromine)
• meropenem
• Orlistat
• Oxcarbazepine
• Phenytoin
• primidone
• rifampin
• Rufinamide
• selective serotonin reuptake inhibitors (SSRIs; e.g., Citalopram, Fluoxetine, Paroxetine, Sertraline)
• Tolbutamide
• Topiramate
• tricyclic antidepressants (e.g., Amitriptyline, Nortriptyline)
• Vorinostat
• Warfarin
• zidovudine

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with Divalproex. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the Nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

Before you begin using a medication, be sure to inform your doctor of any medical conditions or Allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use Divalproex.

Behaviour changes: People taking Divalproex have occasionally experienced aggressive behaviour or hostility, anxiousness, disorientation, or decreased memory. If you experience any of these effects or notice them in a family member who is taking Divalproex, contact your doctor as soon as possible.

Blood clotting: Divalproex may make it more difficult for the blood to clot. If you take anticoagulant medications (blood thinning) medications, discuss with your doctor how Divalproex may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Divalproex, and whether any special monitoring is needed. If you notice any signs of bleeding, such as frequent nosebleeds, unexplained bruising, or black and tarry stools, notify your doctor as soon as possible. Your doctor will order routine blood tests to make sure potential problems are caught early.

Drowsiness/reduced alertness: Divalproex may cause drowsiness, especially when combined with alcohol or another sedating medication. Avoid driving or other potentially dangerous activities until you determine how Divalproex affects you.

Hypersensitivity reaction: A Anaphylaxis (severe allergic reaction) called hypersensitivity reaction has occurred on rare occasions for some people with the use of divalproex, as well as other medications to treat seizures. This reaction involves a number of organs in the body and may be fatal if not treated quickly. Stop taking the medication and get immediate medical attention if you have symptoms of a severe allergic reaction, including fever, swollen glands, yellowing of the skin or eyes, or flu-like symptoms with skin rash or blistering.

Kidney Disease: Kidney disease or reduced kidney function may cause divalproex to build up in the body, causing side effects. If you have reduced kidney function or kidney disease, discuss with your doctor how Divalproex may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Divalproex, and whether any special monitoring is needed.

Liver function: Liver failure has occurred infrequently for people taking divalproex. In most cases, this has happened during the first 6 months of treatment. The risk is highest for children under the age of 2 years, especially those who take more than one antiseizure medication, or those who have certain medical conditions (e.g., metabolic disorders, brain disease, severe seizure disorders accompanied by mental retardation). Children aged 3 to 10 years are also at a higher risk if they take more than one antiseizure medication. Liver function tests should take place before starting treatment with divalproex. Your doctor may also perform liver function tests regularly to monitor the function of your liver. Serious liver problems may happen after symptoms such as loss of seizure control, malaise, weakness, lethargy, loss of appetite, and vomiting. People who take valproic acid should tell their doctor at once if they experience these symptoms. Increases in the levels of ammonia in the blood, with or without lethargy or coma, have been reported and may be present despite normal liver function tests.

Pancreatitis: People taking divalproex have experienced life-threatening pancreatitis (inflammation of the pancreas). These cases have occurred shortly after starting the medication and after several years of taking the medication. If you experience signs of pancreatitis such as abdominal pain on the upper left side, back pain, loss of appetite, nausea, fever, chills, rapid heartbeat, or swollen abdomen, contact your doctor immediately.

Suicidal thoughts: There is a small risk that Divalproex may result in thoughts of suicide. If you experience these symptoms or any other behaviour change while taking Divalproex, contact your doctor immediately. Family members or caregivers of people who are taking Divalproex should contact the person's doctor immediately if they notice unusual behaviour changes.

Stopping Divalproex: People who need Divalproex to prevent major seizures should not stop taking it suddenly as this can increase the risk of getting seizures. Do not stop taking Divalproex without consulting with your doctor first.

Pregnancy: There is an increased risk of serious birth defects for a child whose mother takes divalproex during pregnancy. Divalproex may cause a number of defects including a defect of the spine called Spina Bifida, cleft palate, heart defects, Autism, or slowed or reduced mental development. Divalproex should not be used during pregnancy for treatment of epilepsy unless there is no other suitable alternative treatment. Divalproex should not be used during pregnancy for treatment of bipolar disorder. Women of child-bearing age must use effective contraception while taking Divalproex.

Before becoming pregnant, women who are taking divalproex should speak to their doctor. If possible, a switch to another medication to treat epilepsy should be considered. If you become pregnant while taking Divalproex, contact your doctor immediately.

Breast-feeding: Divalproex passes into breast milk. If you are a breast-feeding mother and are taking divalproex, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding. As a general rule, women who are taking divalproex should not breast-feed.

Children: If divalproex is taken by children 2 years old or younger, it should not be used in combination with other antiseizure medications and the doctor should monitor the child regularly. Divalproex is not recommended for treatment of mania in children under 18 years of age.

Seniors: People over the age of 65 may be more at risk of developing side effects from Divalproex and may require lower dosages.

This medication is typically used twice a day. However, your pharmacist may have suggested a different schedule that is more appropriate for you. It is not advisable to stop using this product suddenly, particularly if you have been on it for several weeks. If you are considering stopping the medication, talk to your pharmacist first. It must be used regularly and continuously to maintain its beneficial effects. Be sure to keep an adequate supply on hand. This medication should be swallowed whole. It should not be split, crushed or chewed. If you forget a dose, take it as soon as you remember -- unless it is almost time for your next dose. In that case, skip the missed dose. Do not double the next dose to catch up. This medication may irritate the stomach, and should be taken with food. It is best to avoid coffee, spicy food or alcohol. Consuming alcohol may intensify the effect of this product. Limit alcohol consumption to occasional small quantities.