US Brand Name: Depakote

generic name: divalproex sodium

Other Forms: Extended-release tablets, sprinkles

Class: Antieplieptic drug (AED)/ Anticonvulsant (AC)

1.  Other brand names & branded generic names¹

Epival (Canada), Valcote (Colombia, Peru)

2.  FDA Approved Uses:

• Epilepsy: Monotherapy (used by itself) and adjunctive treatment (i.e. you must use another drug along with it) for a variety of epileptic seizures. These include complex partial seizures and absence seizures. Depakote is approved for use with epilepsy for adults and children aged 10 and up.
• Bipolar mania
• Migraines

3.  Off-Label Uses

• Treatment for types of Epilepsy not listed (e.g. tonic-clonic seizures)
• Borderline Personality Disorder
• PTSD
• OCD
• Alcohol, Cocaine & other Drug Dependencies
• Anxiety
• PMS
• Sleep Disorders
• Restless Leg & PLMD
• Schizophrenia and Schizoaffective Disorder
• Alzheimer’s-related disorders

4.  Depakote’s pros and cons

4.1  Pros

Proven to be effective for wide spectra of epileptic and bipolar disorders. It’s been around for so long that the long-term effects are well known and well documented. If you can get past the initial side effects and get used to a valproate medication, you don’t have to worry about anything biting your ass in the long run.

4.2  Cons

The side effects suck donkey dong! The valproates are amongst the harshest meds to take. Everyone hates them so much that they’ve given the entire class of anticonvulsants a bad name.

5.  Side Effects

5.1  Typical Side Effects

The usual for anticonvulsants plus a special set for valproates: instant old age. You’ll get fat, bald, tired, confused, uninterested in sex, unable to hold your liquor and everything will give you heartburn and/or the runs.

5.2  Not So Common Side Effects

Edema. Being more prone to respiratory infections. Getting a ringing in your ears.

5.3  Freaky Rare Side Effects

Irreversible deafness (ouch!) and bone pain. I told you you’d get instantly old.

6.  Interesting Stuff Your Doctor Probably Won’t Tell You

• Taking Depakote (divalproex sodium) with food helps reduce a lot of the gastrointestinal problems. In fact the sprinkles capsule is designed to be opened up and mixed in with stuff like “applesauce or pudding”. So if the extended release tablets don’t help with the GI issues, you might try literally mixing the sprinkles with food.
• Depakote (divalproex sodium) interacts with aspirin. Aspirin prevents you from metabolizing Depakote properly, so you’re better off with ibuprofen.
• Your doctor had better damn well be telling you about the regular blood work you need, to check your valproate levels and to make sure your liver is functioning normally.
• Depakote can sap your body of vitamin D, folic acid, and maybe even calcium. So ask your doctor about tests for vitamin D and calcium levels and supplements. You should probably take 400–1,000mcg of folic acid in any event, but no more than that, otherwise it might interfere with how well Depakote works.

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7.  Depakote’s Dosage and How to Take Depakote

Depakote, like lithium, is all about blood levels. It’s also about which FDA-approved ailment we’re discussing. As always it’s adult dosages.

Bipolar disorder - Abbott recommends starting at 750mg a day divided into two doses. I would think that with a 9 to 16-hour half-life three times a day dosing could be useful, and there is a study to back that up. Abbott is all about ramping the dosage up “as rapidly as possible” until you either get the desired clinical effect or you reach the sweet spot of the blood plasma level - somewhere between 50 and 125. They expect you to do that within 14 days and damn any GI trouble you might be having.

What do they think we are crazy or something?

Then, get this, the maximum recommended dosage is 60mg/kg/day. What does that mean? It means if you weigh 150 pounds your doctor could keep upping your dosage to 4,000mg a day if you’re still flipping out! After just two weeks!

That, friends, is crazy.

But just from the point of a starting dosage, beginning with 500mg a day, or even lower, at three times a day seems to be the way to start Depakote. From what I’ve read in the support groups the people whose doctors prescribe it that way bitch about the side effects a lot less. A least some doctors are reading the studies or these data are making it to conferences.

For epilepsy the initial dosage is based on your weight. Why the hell not? Personally I think that’s better than just throwing 750mg a day at someone and ramping up drastically like they recommend for the bipolar. While weight isn’t always a good factor at determining how burly your liver is, until tests of liver enzyme functions are more widely available, it’s as good a guess as any. So you start at 10 to 15mg/kg/day. So for that 150-pound person that’s between 650 and 1,000mg a day. Abbott is all about taking it two times a day. The only study I’ve found that suggests a three-times-a-day dosing schedule for epilepsy was comparing immediate release to extended release. I haven’t found anything regarding starting at a lower dosage for epilepsy in adults to deal with the side effects. I guess this is a case of what sucks less, seizures or side effects?

Anyway, after that you can up the dosage by 5–10mg/kg/day until the seizures abate or you max out at 60mg/kg/day or you reach the sweet spot of blood levels between 50 & 100.

For migraines you start at 250mg taken twice a day (hey, it’s the minimum 500mg a day that seems to work). After that you can move up to 750mg a day then 1,000mg a day. Clinical trials don’t support dosages higher than that and I haven’t researched migraines.

For everything else, it’s up to your doctor and whatever studies your doctor is following.

8.  How Long Depakote Takes to Work

In theory you should start feeling results once you’re in the therapeutic range of your blood levels. So for epilepsy that’s generally in the neighborhood of 50–100, and for bipolar it’s a wider range of 40–150. Getting to that blood level is between you and your liver. Once there it’s up to your brain if it’s going to respond to a valproate or not. So unlike most anticonvulsants where you feel something in a matter of days, or there’s a definite dosage where we can write, “here is where you should notice effect or not,” it’s just not like that with the valproates.

9.  How to Stop Taking Depakote

Your doctor should be recommending that you reduce your dosage by however much you increased it (keep good records about that!) a day every two to three days at the quickest, based on the 9–16 hour half-life. But it’ll probably be slowly than that, with at least one blood level thrown in for shits & grins. For more information, please see the page on how to safely stop taking these crazy meds.

Like any anticonvulsant, if you’ve been taking Depakote for more than a couple months and you’ve reached the therapeutic blood levels, you just can’t stop cold turkey if you’re not at the therapeutic dosage for another anticonvulsant that is known to work for you, otherwise you risk partial onset or absence seizures to tonic-clonic grand mals, even if you’ve never had a seizure disorder before! The risk is worse if you’re taking a lithium variant, and/or any antidepressant, especially Wellbutrin. Anyone with a history of a seizure disorder who needs to stop taking an anticonvulsant cold turkey needs to be discussing that with two neurologists and not getting your information from some stupid web site. Get off your computer and start making appointments!

10.  Depakote’s Half-Life & Average Time to Clear Out of Your System

Half-life: 9–16 hours. It’s out of your system in 2–3 days.

11.  Days to Reach a Steady State

Depakote’s non-linear. So that’s why it’s good for borderline personality disorder! Anyway, that means you can’t pin down a hard number on it. I haven’t found a number for it in any study.

12.  Discussion board

Crazy Meds’ Depakote discussion board

13.  Your Comments About and Experiences with Depakote

Tell us what you think about Depakote

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Enter your own Comments & Experiences with Depakote here.
You must be a registered member of the Crazy Meds Talk forum to post a comment on this page.

14.  Full US PI sheet, Global SPCs & PILs, check for drug-drug interactions

Depakote Full US Prescribing Information / PI Sheet

Check for drug-drug interactions

15.  Bibliography

Physicians’ Desk Reference Edition 56 Maria Deutsch & Anu Gupta, Drug Information Specialists, et al. © 2002. Published by Medical Economics Company.

Instant Psychopharmacology 2nd Edition Ronald J. Diamond M.D. © 2002. Published by W.W. Norton

A Primer of Drug Action Robert M. Julien, M.D., Ph. D. © 2001. Ninth Edition.

The Complete Guide to Psychiatric Drugs Edward Drummond, M.D. © 2000. Published by John Wiley & Sons, Inc.

Partial Seizure Disorders Mitzi Waltz © 2001. Published by O’Reilly & Associates.

Mosby’s 2004 Drug Guide David Nissen PharmD, Editor.© 2004. An imprint of Elsevier.

The Bipolar Disorder Survival Guide David J. Miklowitz, Ph.D. © 2002. Published by The Guilford Press.

¹ The term "branded generic" has three meanings:
1) A generic drug produced by a generics manufacturer that is a wholly-owned subsidiary of the company that makes the branded version. E.g. Greenstone Pharmaceuticals makes gabapentin, and they are owned by Pfizer, who also own Parke-Davis, the makers of Neurontin.
2) A branded generic is also a generic drug given a 'brand' name by the manufacturer (e.g. Teva's Budeprion), but otherwise has the same active ingredient as the original branded version (Wellbutrin).
3) A branded generic is also a generic drug given a 'brand' name by the manufacturer (e.g. Sanofi-Aventis' Aplenzin, which is bupropion hydrobromide) and uses a salt of the active ingredient that is different from the original branded version and other generics (Wellbutrin, Budeprion and all the others are bupropion hydrochloride). We aren't sure if that really makes a difference or not. The FDA says they're the same thing. As usual, the data are contradictory, but most evidence indicates that the FDA is right and the differences are negligible.
For our purposes a "branded generic name" refers to the second and third definitions.

Date created 25 Apr 2011 - 13:34 Page Creator: JerodPoore Last edited by:

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Almost all of the material on this site is copyright © 2004, 2005, 2006, 2007, 2008, 2009, 2010, 2011, and 2012 Jerod Poore. Except, of course, the PI sheets - those are the property of the drug companies who developed the drugs the sheets are about - and any documents that are written by other people which may be posted to this site will remain the property of the original authors. You cannot reproduce this page or any other material on this site outside of the boundaries of fair use copying without the express permission of the copyright holder. That’s usually me, so just ask first. That means if want to print out a few pages to take to your doctor, therapist, counselor, support group, non-understanding family members or something like that - then that’s OK to just do. Go for it! Please. As long as you include this copyright notice and the following disclaimer, I’m usually cool with it.

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¹ While there are plenty of books to help you with hypochondria, for some reason there’s not much in the way of websites. Then again, staying off of the Internet is a large part of curing/managing the disorder.

² Have I mentioned how open source operating systems for commercial applications is one of the dumbest ideas in the history of dumb ideas?
[begin rant] I rent a dedicated server for Crazy Meds. It’s sitting on a rack somewhere in Southern California along with a bunch of other servers that other people have rented. The hardware is identical, but no two machines have exactly the same operating systems. I don’t even need to see what is on any of the others to know this. If somebody got their server at the exact same time, with the exact same features as I did, I’m confident that there would be noticeable differences in some aspects of the operating systems. So what does this mean? For one thing it means that no two computers in the same office of a single company have the same operating system, and the techs can spend hours figuring out what the fuck the problem could be based on that alone. It also means that application software like IP board that runs the forum here has to have so many fucking user-configurable bells and whistles that even when I read the manual I can’t find every setting, or every location that every flag needs to be set in order for a feature to run the way I want it to run. And in the real world it means you can get an MBA not only with an emphasis on resource planning, but with an emphasis on using SAP - a piece of software so complex there are now college programs on how to use it. You might think, “But don’t people learn how to use Photoshop or Adobe Illustrator in college?” Sure, in order to create stuff. And in a way you’re creating stuff with SAP. But do you get a Bachelor of Fine Arts degree with an emphasis on Photoshop?
Back in the Big Iron Age the operating systems were proprietary, and every computer that took up an entire room with a raised floor and HVAC system, and had less storage and processing power than an iPhone, had the same operating system as every other one, give or take a release level. But when a company bought application software like SAP, they also got the source code, which was usually documented and written in a way to make it easy to modify the hell out of it. Why? Because accounting principles may be the same the world over, and tax laws the same across each country and state, but no two companies have the same format for their reports, invoices, purchase orders and so forth. Standards existed and were universally ignored. If something went wrong it went wrong the same way for everyone, and was easy to track down. People didn’t need to take a college course to learn how to use a piece of software.
I’m not against the open source concept entirely. Back then all the programmers read the same magazines, so we all had the same homebrew utilities. We even had the forerunner to QR Code to scan the longer source code. Software vendors and computer manufacturers sponsored conventions so we could, among other things, swap recipes for such add-ons and utilities. While those things would make our lives easier, they had nothing to do with critical functions of the operating system. Unless badly implemented they would rarely cause key application software to crash and burn. Whereas today, with open source everything, who the hell knows what could be responsible some part of a system failing. [/end rant]