Older people metabolize valproate more slowly than younger adults and they are often more susceptible to side effects. Lower initial doses and caution in titration are required. A total daily dose of 5-10 mg/kg per day is appropriate for many elderly patients. The smallest dose of Depakote ER, 250 mg, may be too high as an initial dose for some seniors, who will have to begin by taking regular Depakote and converting to Depakote ER later.

Reduced elimination extends the half-life of valproate for elderly patients, so that many need to take regular Depakote only once a day. They may still benefit from the more even blood levels produced by Depakote ER.

Side effects such as sleepiness, depression, or weight gain may exacerbate pre-existing problems of seniors, and their greater risk of injury from falls or other accidents makes this an area of concern. Tremor is a common side effect of valproate and is sometimes mistaken for a parkinsonian tremor. The less extreme blood level fluctuations with Depakote ER may reduce this problem. Nevertheless, other antiepileptic drugs may be preferable for patients with Parkinson's disease.

Interactions with other medications are less common with valproate than with some other antiepileptic drugs but still may be a concern. Changes in dosages of both medications are often required.