Download Antiepileptic Medication: Depakote, Depakote ER (valproic acid)

Antiepileptic Medication:
Depakote, Depakote ER (valproic acid)
General Information
Depakote was approved for use in the United States in
1978. It is an effective treatment for partial and
generalized seizures.
How does it work?
Depakote increases the amount of GABA. GABA is a
chemical that blocks electrical signals in the brain.
Depakote also reduces the amount of chemicals in the
brain that excite nerve cells.
Available forms
This drug was initially developed as Depakene. This is a
short acting form and was not well tolerated. Depakote
ER (extended release) was later created and is the most
commonly used form. There are also sprinkles
available. The sprinkles have time-released capsules
inside the capsule that may be added to food. It is
available in the following doses:
▬ Liver failure. You might see abnormal
bleeding, abdominal pain, high ammonia
levels and liver enzymes, yellowing of skin
and eyes.
▬ Fewer platelets
▬ It may take longer to stop bleeding.
▬ Temporary hair loss, change in hair color, or
hair may be unusually curly.
•
Dose-related:
▬ Tremor (10%)
▬ Nausea & vomiting (8%)
•
Initiation: You may notice some dose-related side
effects during the first couple of weeks of treatment.
Your body should get used to the medication if you
give it a chance.
You need to report any symptoms of severe abdominal pain,
increased bruising and bleeding, and severe drowsiness. You
may be asked to stop the medication.
•
•
•
Drug basics
It will take 30 minutes to 2 hours for the Depakene or
Depakote to reach a peak dose. Depakote ER may take
3-8 hours to peak. You might be more aware of dose
related side effects at this time if you have them. Half of
the drug will be out of your body in 12 to 17 hours. This
allows you to take the medication twice a day. Almost
85-95% of the drug is bound to proteins. This bound
portion of the drug is not active. It is metabolized in the
liver and excreted in the urine.
Side Effects
There are 3 different types of side effects:
• Drug specific:
▬ Inflammation of the pancreas: severe
stomach pain followed by nausea and
vomiting.
Created by Diana Murray RN, CNS, MS, CNRN & Mark Yerby MD, MPH
Portland, Oregon
Interactions
Potential for many drug-drug interactions with comedication.
Depakote slows down the metabolism of many
drugs, which could lead to side effects & toxicity.
Lamictal levels can be increased by 50%.
Tegretol, Dilantin, and Phenobarbitol may increase
the speed that Depakote is metabolized and may
result in ineffectiveness.
Lab Monitoring
We are able to check a Depakote level easily. The reference
range is typically 50 to 100. Patients who are not well
controlled, may need to be as high as 130. It is not necessary
to perform blood levels on a regular basis. It is more
important to know how you are doing.
Pregnancy
Use of Depakote in pregnancy may increase the risk of:
• Spina bifida
• Cardiovascular malformations
• Defects to the head and face.
• Cognitive delay
Final Note
If you are having difficulty with you medication, please
notify your doctor.
1/13/2010