As a broad-spectrum antiepileptic drug, Depakote ER can be effective against many types of seizures common in children. Other forms of valproate have been used for many years to treat children with absence seizures, for which it is just as effective as Zarontin (ethosuximide). These two drugs can be used in combination. Valproate also is the first-choice drug for myoclonic seizures in adolescents, including those with juvenile myoclonic epilepsy. It can be effective against generalized tonic-clonic seizures in children, and is a first choice for Lennox-Gastaut syndrome. Valproate is sometimes used to treat infantile spasms (West syndrome), but Depakote ER's tablet form makes it unsuitable for this purpose. It also controls photosensitivity.

The risk of liver failure is much higher in children under 2 or 3 years of age who take any form of valproate, especially if they are also taking other antiepileptic drugs or if they have a congenital metabolic disorder, a severe seizure disorder with mental retardation, or other brain disease. These children are not candidates for the use of Depakote ER. Consult a pediatric epileptologist before prescribing other forms of valproate for a child who meets these criteria. The risk of liver failure is much lower in children between 2 and 10 and is very low in older children, perhaps 1 in 50,000.

Elevated testosterone levels have been reported in many peripubertal girls taking valproate. Clinical consequences were not evident, but a connection to the later development of polycystic ovary syndrome is possible. Weight gain in these girls may be related to these changes.

Occasionally behavioral changes such as irritability are reported in children who take valproate, though it is usually well tolerated.

The initial dose of valproate for children may be 5-10 mg/kg per day. Since Depakote ER tablets are available only in 250-mg and 500-mg doses, smaller children (even if they can swallow the tablet) may need to begin by using another form of valproate and switch to Depakote ER when they reach a higher dosage. (To achieve bioequivalence, the dose of Depakote ER will need to be 8% to 20% higher than the total daily dose of regular Depakote.)

Steady state is reached after about 2 days. The half-life is shorter for children than for adults, so children may require higher doses than adults, commonly 15-60 mg/kg per day. The higher doses are usually needed by children taking combination therapy. Interactions between medications may be so pronounced in children that some never reach the usual therapeutic level of valproate, even with very high doses.

Children's blood levels of valproate fluctuate considerably over the course of a day and are not clearly related to clinical results, so single measurements have limited value for most patients. Depakote ER should help to reduce these fluctuations.