Depakote (DEH-pah-kote) is a brand name used in the United States for a type of medicine called divalproex (di-VAL-pro-eks) sodium. The same product is known as Epival in Canada. It is not available in every country.
The active ingredient in Depakote changes in the body to valproate (val-PRO-ate), so you may also see this name used if you read about Depakote. A few other medicines also become valproate, so their effects are virtually identical. The other valproate medicines in the United States are Depakene, Depacon (given by injection), and some generic (non-brand name) forms. Depakote is not available in generic form.
Depakote has been available in the United States since 1983, so doctors have plenty of experience in using it.
125-mg (salmon pink)
250-mg (peach color)
125-mg Sprinkle capsules (white and blue)
Capsules oversized for easy opening
Used to treat
- Absence Seizures
- Simple Partial Seizures
In the United States, Depakote is sold by Abbott Laboratories. The name or appearance may be different in various countries but usually the dose (measured in milligrams, abbreviated "mg") will be the same. These descriptions apply to the U.S. versions:
Please see package insert.
Follow the doctor's directions. Call if you have any questions. Ask the doctor what to do if you forget a dose. The way the medicine is taken depends, of course, on what form the doctor has prescribed.
Most doctors recommend taking Depakote with food to avoid an upset stomach, but it can also be taken without food. Because food affects the way medicine is used by the body, try to be consistent day in and day out. A person who usually takes Depakote with meals should do that all the time.
The sprinkle capsule is a way for small children or older people who have trouble swallowing pills to take Depakote. The capsule can be swallowed whole, but it is designed to be opened. Sprinkle all the contents onto a teaspoon of soft food such as applesauce, custard, ice cream, oatmeal, pudding, or yogurt. Combine the medicine and the food. Then it should all be swallowed right away, without chewing. Drinking a glass of water or another liquid may help with swallowing. Don't save any of the mixture for later.
As the doctor increases the amount of Depakote, you may be given a different kind of pills than the ones you've been using. For example, you may start out using 250-mg tablets and then switch to 500-mg tablets. If this happens, be careful to use the correct number. Don't automatically continue to use the same number of pills as before.
Store both types of Depakote at room temperature and keep the pills away from light and dampness. Don't keep them in the bathroom if it's damp there. And of course keep both kinds where children can't get at them.
In general, if you forget a dose, take it as soon as you remember. If it is almost time for the next dose, delay that dose for a few hours, instead of taking two doses very close together. Then go back to the regular schedule. If you're not sure about what to do, call the doctor's office for more advice.
Do your best to follow the doctor's directions. The more often a medicine must be taken, the greater the chance of forgetting, and some people need to take Depakote three or four times every day. This can be difficult. If you forget doses often, it may be a good idea to get a special pillbox or watch with an alarm to remind you. You also might ask the doctor whether you can switch to Depakote ER, which is taken only once a day.
Taking the right amount of seizure medicine on time every single day is the most important step in preventing seizures!
Brain cells need to work (fire) at a certain rate to function normally. During a seizure, brain cells are forced to work much more rapidly than normal. Depakote helps prevent brain cells from working as fast as a seizure requires them to. In this way, seizures can be stopped when they are just beginning.
We don't completely understand how Depakote works. Doctors think that it may work in several ways at once. That could be why it works for so many different kinds of seizures.
After medicine is swallowed, it must be absorbed into the blood so it can move throughout the body. The process of absorbing, digesting, and excreting a medicine or food is called metabolism. The way the body metabolizes a particular medicine affects how often it must be taken. It also determines whether it will interact with other medicines or be affected by conditions such as liver disease.
Depakote is absorbed a bit more quickly if the sprinkle capsule is used than if the regular tablets are taken, but in the end the amount absorbed is about the same. Taking Depakote with a meal instead of on an empty stomach also slows absorption. That's why it helps to be consistent.
Like many other medicines, Depakote is broken down (digested) in the liver. People with liver disease should not take it. Anyone who also takes other medicines that are digested in the liver need to be careful. How well each medicine works and how quickly it leaves the body may be changed.
This is why the doctor needs to know about everything that a person takes—not just prescription medicines but even things like vitamins, herbs, and aspirin! These things can affect how much Depakote the doctor prescribes.
Doctors have studied large numbers of people to find out how well Depakote and the other medicines that contain valproate control seizures. (There is hardly any difference in the way the different valproate medicines work.) They have reported that Depakote is very good at completely controlling absence seizures in many people who take it. In another group, over 80% of people with new tonic-clonic seizures and related types didn't have any seizures during the period when they were given Depakote.
These promising results are not always matched in everyday life. Sometimes people don't take all their medicine on time. Not everyone's seizures can be controlled at a dose that can be taken without side effects. Because of individual differences, there is no "best" amount for everyone. Adjustments are often needed to reduce seizures or side effects.
In studies of seizure medicines, some people do better with Depakote and others do better with something else. It's difficult to forecast the results for any given person. Differences in side effects may be important in deciding which medicine is best for each person.
If seizures continue, the doctor probably will change the amount of Depakote prescribed. If that doesn't work, the next step may be either to prescribe a different seizure medicine by itself or to prescribe a combination of Depakote and another seizure medicine. Many are available. No single combination is best for everyone. Depakote is often used as an "add-on" medicine for people who continue to have certain kinds of seizures while taking other seizure medicines.
Most people who take Depakote don't have too much trouble with side effects. That's one of the reasons it's used so much. The most common complaints (usually not too severe) are:
- tiredness (sometimes with slower thinking)
- upset stomach
- tremor (shaking of the hands or other parts of the body)
- hair loss
- weight gain
- changes in behavior (depression in adults, irritability in children)
If you notice any of these problems, call the doctor. Sometimes the doctor can help by changing the amount or type of Depakote prescribed. No one should stop taking Depakote or change the amount they take without their doctor's guidance.
Stomach upset from Depakote may be less of a problem if the pills are taken on a full stomach. Stomach upset is more likely when another seizure medicine with similar side effects (for example, Tegretol) is also being used.
Tremor (shaking of the hands or other body parts) tends to be worse when the level of Depakote in the blood is highest, a few hours after the pills are taken. Anxiety or caffeine also may make it worse.
Weight gain affects 30% to 50% of people who take Depakote. It is more common in adult women but can affect anyone. The average gain for adults is 15 pounds. Exercise and a reduced-calorie diet can be very helpful. It's uncertain whether weight gain is greater when higher doses of Depakote are taken.
Hair loss occurs in 5% to 10% of people who take Depakote. The hair almost always grows back after the Depakote is stopped, but it often has a different texture. (For example, it may grow in curly instead of straight.)
People who have just started taking Depakote (or who have just started taking a larger amount) should be careful during activities that might be dangerous, until they know whether they are having any side effects.
Allergic reactions such as rashes are less common with Depakote than with most other seizure medicines. Even so, you should report any rash to the doctor or nurse right away, especially if Depakote treatment has just begun. It's rare for the rash to be serious, but don't ignore it. It's often necessary to switch to a different seizure medicine.
A very small number of people who take Depakote develop life-threatening disorders. Children younger than 2 years of age and other people who are taking more than one seizure medicine have the greatest risk. See Serious side effects.
Long-term side effects
Some people who have taken Depakote for many years have experienced bone loss and a few other disorders. Taking both calcium and vitamin D may help to prevent this kind of problem. Doctors sometimes recommend a bone density test to identify which people need treatment for bone loss.
A few people have serious reactions to Depakote. These problems are very rare but everyone who takes this medicine should at least be aware of them because a very small number of people have died because of them.
Here's a list of warning signs that may be the start of one of these problems. If you notice any of these things, call the doctor immediately:
- weakness, sluggishness, swelling of the face, loss of appetite, vomiting, yellowish eyes or skin, especially in a child under 2 years of age (possible liver failure)
- pain in the abdomen, upset stomach, vomiting, or loss of appetite (possible disease of the pancreas)
- easy bruising, nosebleed, other abnormal bleeding (problems with clotting)
Tell the doctor right away if you notice any of these problems, but don't stop using the Depakote unless the doctor says so.
The best-known and most-feared serious reaction is liver failure. This disorder usually occurs within the first 6 months of treatment. The risk of liver failure is much higher in children under 2 years of age, especially if they also take other seizure medicine or already have other serious disorders.
The risk of liver failure is much lower in children between 2 and 10. The risk is very low in older children and adults, perhaps 1 in 50,000. There is no evidence that long-term use of Depakote will cause gradual damage to the liver.
Another rare reaction to Depakote is a disorder of the pancreas. Occasionally it is so severe that bleeding and death can occur. Both children and adults can be affected, even after several years of taking Depakote. Report pain in the abdomen, upset stomach, vomiting, or loss of appetite to the doctor right away.
Problems with blood clotting are more likely in people who take large amounts of Depakote. Sometimes the blood returns to normal without stopping the Depakote. The doctor probably will order some blood tests before prescribing Depakote, and will repeat them some time later and before any elective surgery.
A complete list of all reactions to Depakote can be found in the package insert, but it is important to remember that only a tiny number of people have any of these serious problems.
On July 10, 2008, an advisory panel was convened by the Food and Drug Administration (FDA) to review data that the FDA had previously collected from drug studies showing an association between many of the antiepileptic drugs (AEDs) and suicidal ideation and behavior, which together are called suicidality. According to the FDA’s Alert, among the patients with epilepsy in these drug studies, 1 out of 1000 people taking the placebo (inactive substance) showed suicidality compared to approximately 3.5 out of 1000 people who took an AED. The FDA advisory panel voted to accept the FDA's data at its meeting on July 10. The FDA has provided the following information for patients, family members, and caregivers at http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm100192.htm.
- Taking antiepileptic medicines may increase the risk of having suicidal thoughts or actions;
- Do not make any changes to the medication regimen without first talking with the responsible healthcare professional;
- Pay close attention to any day-to-day changes in mood, behavior and actions. These changes can happen very quickly so it is important to be mindful of any sudden differences.
- Be aware of common warning signs that might be a signal for risk of suicide. Some of these are:
- Talking or thinking about wanting to hurt yourself or end your life
- Withdrawing from friends and family
- Becoming depressed or having your depression get worse
- Becoming preoccupied with death and dying
- Giving away prized possessions
We again urge patients and families to contact their doctor before stopping an epilepsy medication because this may possibly lead to seizures and worsening of mood.
People with epilepsy taking certain seizure medications are at higher risk than other people for developing osteoporosis and fractures. Many studies have shown an association between antiseizure medications and osteoporosis, particularly with older medications such as phenytoin (Dilantin), carbamazepine (Tegretol, Carbatrol), primidone (Mysoline), and valproic acid (Depakote).
- Talk to your treating health care provider about your risks for thinking of the bones, bone loss and fractures or broken bones.
- Pay attention to getting enough exercise, sunlight and eating healthy.
- Ask about ways to lessen your risks, such as the use of calcium, vitamin D or other medications.
Depakote has been used successfully for many years to treat epilepsy, but it also has been approved by the Food and Drug Administration (FDA) for two other uses:
- preventing migraine headaches (not treating headaches while they're occurring)
- treating one part of the mental illness called bipolar disorder.
People with liver disease should not take Depakote. Neither should anyone who has shown an allergy to Depakote in the past. Make sure the doctor knows about any liver problems, so a different medicine can be prescribed instead.
Sometimes one kind of medicine changes the way another kind of medicine works in the body. This is true not only for prescription medicines, but also for medicines you just pick up off the shelf at the store. For instance, aspirin (ASA) may increase the side effects from taking Depakote.
If someone who is taking Depakote-especially a child-also starts to take the seizure medicine called Lamictal, the chances of a very dangerous rash will be increased. Adding the Lamictal slowly reduces this danger.
Taking both Depakote and another seizure medicine, Klonopin, sometimes causes absence seizures to be much longer.
Any time a doctor suggests a new prescription, be sure to talk about what other medicines you are already using. If two kinds of medicine affect each other, the doctor may want to prescribe something else or change the amount to be taken.
How does Depakote affect other medicines
Depakote affects the way the body handles many other seizure medicines. Some of these are:
- Felbatol (felbamate)
- Lamictal (lamotrigine)
- Mysoline (primidone)
If a person taking one of these medicines starts taking Depakote, the first medicine will stay in the body longer. If the person keeps taking the same amount as before, soon there will be too much of it. This may cause side effects like extreme tiredness and slurred speech. The person might seem to be drunk.
A similar thing could happen with several other seizure medicines, but the effects for people taking these would probably not be too noticeable:
- Tegretol or Carbatrol (carbamazepine)
- Zarontin (ethosuximide)
- Ativan (lorazepam)
- Dilantin or Phenytek (phenytoin)
All of these effects mean that if a person taking another seizure medicine starts taking Depakote too, the amount of the first medicine may need to be changed. Or if a person has been taking Depakote along with another seizure medicine, stopping either one of them means that the amount of the other one probably will have to be changed.
How do other medicines affect Depakote:?
Some other medicines do affect the way Depakote works in the body. Make sure that the doctor is aware of all the medicines being used.
Depakote can be effective against many types of seizures common in children:
- absence seizures (Depakote is one of the most effective medicines for these brief staring spells)
- myoclonic seizures
- tonic-clonic seizures, such as those in Lennox-Gastaut syndrome.
- infantile spasms
- seizures triggered by flashing lights
Children under 2 or 3 years of age who take Depakote have a much higher risk of liver failure than adults or older children. (The risk is very low for children over 10, perhaps 1 in 50,000.) The risk is even higher for very young children who also take other seizure medicines, and it's highest of all for those with certain other serious disorders. Usually the doctor will not prescribe Depakote for children at very high risk. Liver damage usually occurs within the first 6 months of treatment. The first signs of it are vomiting, loss of appetite, sluggishness, and perhaps loss of seizure control, yellow skin and eyes, or swelling.
Higher-than-usual levels of the hormone testosterone have been found in many girls who take Depakote when they're older than about age 10. No symptoms are apparent, but the doctor may want to watch for later problems, perhaps related to weight gain.
A few children who take Depakote seem to become more irritable but this is seldom a serious problem.
To reduce side effects, the doctor probably will prescribe a low dose of Depakote to start and increase it slowly. Children usually start with a dose of 5 to 10 milligrams (mg) for each kilogram (kg, about 2.2 pounds) of their body weight per day. This is usually given in two to four equal doses per day.
Most children do best at about 15 to 60 mg/kg per day. Children taking a combination of Depakote and another seizure medicine usually need the higher doses because of interactions between the medicines.
The sprinkle capsule is an easy way to give Depakote to small children who cannot swallow tablets. The child's body absorbs the same amount of medicine, but it happens a bit more quickly than with the tablets.
In the United States, the Food and Drug Administration (FDA) assigns each medication to a Pregnancy Category according to whether it has been proven to be harmful in pregnancy. Depakote is listed in Pregnancy Category D. This means that there is a risk to the baby, but the benefits may outweigh the risk for some women.
In fact, a large majority of women who use Depakote during pregnancy have normal, healthy babies. Certain types of defects are increased (especially if Depakote is taken during the first 3 months of pregnancy) but they are still relatively uncommon. The risk of defects is higher for women who take more than one seizure medicine. Women with a family history of birth defects also have a higher risk.
The babies of women taking valproic acid have a greater than usual number of minor craniofacial abnormalities, organ malformations, limb deficiencies, or developmental delay. The risk of defects is higher for women who take more than one AED and for women with a family history of birth defects. Moreover the NEAD study showed that children born to women who took Valproic acid, had lower IQ scores than children born to women with epilepsy who tool other seizure medications.
Women with epilepsy who are pregnant or thinking about becoming pregnant should talk to their doctor about their seizure medicines. Taking more than one seizure medicine may increase the risk of birth defects, so doctors sometimes gradually reduce the number or amount of seizure medicines taken by women planning for pregnancy. This is not done routinely, however, because it increases the risk of seizures. Some kinds of seizures can injure the baby, so do not stop using seizure medicines or reduce the amount without the doctor’s OK.
All women who are capable of becoming pregnant should take at least 400 mcg (0.4 mg) of the vitamin called folic acid every day because it helps to prevent one type of birth defect. (The most well-known of these is spina bifida, in which the spinal cord is not completely enclosed.) These defects are more common in the babies of women who take Depakote during the first 4 to 6 weeks of pregnancy. If the doctor thinks a woman is at especially high risk, a much larger dose of folic acid—4000 mcg (4 mg) per day—may be recommended. There's no proof that the folic acid will prevent the defects, however, so the doctor may recommend a check-up later in pregnancy.
About 20% to 35% of women have seizures more often during pregnancy because of changes in hormones or changes in how their seizure medicine is handled by the body. It is helpful for the doctor to check the levels of medicine in the blood regularly during pregnancy so that the dosage can be adjusted if necessary.
Breast-feeding by mothers taking Depakote should be safe for healthy, full-term newborns. The amount of medicine the baby gets through the milk is much less than the amount that doctors safely give to babies who take Depakote for seizures.
A recent large study has found that children who took this drug during pregnancy had children with lowered IQ and a risk of autism. If you are a woman on this drug and considering pregnancy, please talk to your doctor.
Doctors have prescribed Depakote to people over 65 for many years with good results. These seniors do have a few special problems, however.
Most seniors take more medicines than younger people, so there’s a greater risk that the medicines may affect each other. Usually seniors can continue to take all the medicines they need, including Depakote, without trouble if the doctor changes the amount of some of them to make up for the way they affect each other.
Seniors also tend to be more sensitive than younger adults to medicines and their side effects. For instance, many seniors have a problem with sleepiness, depression, weight gain, or shaking of the hands even before they start taking Depakote. These are common side effects of this medicine, so these problems may become worse and cause real trouble.
Seniors also face more danger from some side effects because they are more likely to be seriously hurt if they fall or have another kind of accident.
To reduce side effects, the doctor probably will prescribe a very low dose of Depakote to start and then be cautious about any increases. It’s especially important for seniors to keep the doctor informed about any changes that they notice.
The best amount is the amount that completely controls seizures without causing troublesome side effects. It depends on many factors, which are different for every individual. Follow the doctor's directions. Call if you have any questions.
No one should stop taking Depakote or change the amount they take without talking to the doctor first. Stopping any seizure medicine all at once can cause a problem that may be life-threatening.
Don’t use more than the doctor prescribes. If a little extra (such as one or two extra tablets) is taken by accident, call the doctor for advice. For a larger overdose, call a poison control center or emergency room right away unless you have other specific directions from your doctor.
To avoid unwanted side effects, the doctor will prescribe a low dose to start and increase it gradually until the seizures are controlled, unless side effects get too bad first. Most people need to take Depakote two to four times a day.
Please see package insert.
In the United States, companies that manufacture medicines are required to publish certain kinds of information about each product. This document is commonly known as a “package insert” because it is usually included with each package of the medicine.
You can also read these documents (also called "prescribing information") online.
The U.S. package insert for Depakote tablets is found at:
The U.S. package insert for Depakote sprinkle capsules is found at:
Some of the information may differ in other countries.
To learn how to read and understand a package insert, see "How to read a package insert."