Common use

Divalproex contains Divalproex sodium, the substance which interacts with certain substances in the brain and increases the concentration of gamma-aminobutyric acid (GABA), which is a neurtransmitter. The drug is used to treat seizure disorders, the manic phase of bipolar disorders, to prevent migraine headaches.



Dosage and direction

The recommended initial dose for treatment of acute mania due to bipolar disorder is 750 mg daily taken in divided doses. For prevention of migraines take 250 mg twice daily. To treat seizures take initial dose calculated as 10-15 mg/kg/day, the dose should be increased gradually by 5-10 mg/kg/day every week to achieve the desired effect. Do not exceed the recommended dose and follow all recommendations of your health care advisor. Drink plenty of water during treatment. Liver function should be controlled on a regular basis to avoid harmful effects. Swallow the pill whole, do not crush or chew it. Inform your doctor immediately if you suppose that the medication does not work properly to prevent seizures. Do not stop taking the medicine without your doctor's permission even if you feel better.



Precautions

Life-threating hepatic failure may develop, this is most likely to occur in children under two years of age especially if they if they have a metabolic disorder or a brain disease causing mental impairment (multiple sclerosis, Huntington disease, Creutzfeldt-Jacob disease, a brain injury or infection). Liver failure symptoms include malaise, lethargy, weakness, facial edema, vomiting, anorexia. Divalproex also may cause rare cases of pancreatitis resulting in fatalities, which may suddenly appear even after several years of treatment with Divalproex. Dose adjustment is needed in the patients with a bleeding or blood clotting disorder, a history of brain disorder, head injury, or coma, a family history of a urea cycle disorder, a family history of infant deaths with unknown cause, HIV or CMV (cytomegalovirus) infection. Suicide thoughts are also possible during treatment with the drug.



Contraindications

The medication cannot be administered to the patients with hepatic diseases, significant hepatic dysfunction known urea cycle disorders.



Possible side effect

The most common reported side effects are: nausea, somnolence, dizziness, vomiting, asthenia, abdominal pain, dyspepsia, rash, diarrhea, weight loss, tremors, low fever, dark urine, clay-colored stools. In some cases alopecia (loss of hair), itching and sensitivity to sunlight occur. More rare but serious adverse reactions include pancreatitis, liver injury, and abnormal bleeding. Liver is more likely to occur in children. The risk increases when a patient is taking two more more anti-seizure drugs. Symptoms of damaged liver are malaise, weakness, jaundice, swelling in the face, vomiting, loss of appetite.



Drug interaction

The following drugs may interact with Divalproex: topiramate (Topamax), tolbutamide (Orinase), a blood thinner such as warfarin (Coumadin), aspirin or acetaminophen (Tylenol), clozapine (Clozaril, FazaClo), diazepam (Valium), zidovudine (Retrovir), meropenem (Merrem), rifampin (Rifadin, Rimactane, Rifater), ethosuximide (Zarontin), indomethacin (Indocin), nabumetone (Relafen), ibuprofen (Motrin, Advil), naproxen (Naprosyn, Aleve), diclofenac (Voltaren, Cataflam, Arthrotec), ketorolac (Toradol) and aspirin. Such medicines as warfarin or heparin if used concomitantly with Divalproex may affect blood clotting and lead to abnormal bleeding. Aspirin and felbamate (Felbatol) reduce catabolism of Divalproex and hereby increase its blood concentrations. On the contrary phenytoin (Dilantin), Rifampin (Rifadin; Rimactane), carbamazepine (Tegretol) reduce its blood concentrations. Absorptin of Divalproex is reduced by Cholestyramine (Questran), therefore intake of Divalproex should be separated by at least two hours before or six hours after doses of cholestyramine.

Divalproex can significantly increase concentrations in blood of lamotrigine (Lamictal), zidovudine (AZT), ethosuximide (Zarontin), diazepam (Valium) and phenobarbital, thereby increasing their concentrations in blood.



Missed dose

Never take a double dose of this medication. If it is almost time of the next dose just skip the missed portion and continue to take the medicine according to the schedule.



Overdose

Divalproex overdose symptoms include weak pulse, drowsiness, shallow breathing, somnolence, heart block, loss of consciousness, and deep coma. In case of the suspected overdose contact your doctor immediately and seek for immediate medical attention.



Storage

Store at room temperature 15-30 C (59-86 F) away from moisture and heat.



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