Buy Depakote Online

What is Depakote?

Depakote (divalproex sodium) affects chemicals in the body that may be involved in causing seizures.

Depakote is used to treat various types of seizure disorders. It is sometimes used together with other seizure medications.

Depakote is also used to treat manic episodes related to bipolar disorder (manic depression), and to prevent migraine headaches.

Depakote may also be used for purposes not listed in this medication guide.

Important information about Depakote

Do not use Depakote to prevent migraine headaches if you are pregnant.

If you take Depakote for seizures or manic episodes: Do not start or stop taking the medicine during pregnancy without your doctor's advice. Divalproex sodium may cause harm to an unborn baby, but having a seizure during pregnancy could harm both the mother and the baby.

You should not use Depakote if you have liver disease, a urea cycle disorder, or a genetic disorder such as Alpers' disease or Alpers-Huttenlocher syndrome (especially in a child younger than 2 years old).

Depakote can cause liver failure that may be fatal, especially in children under age 2 and in people with liver problems caused by a genetic mitochondrial (MYE-toe-KON-dree-al) disorder.

Call your doctor at once if the person taking this medicine has early signs of liver damage, such as: loss of appetite, upper stomach pain, ongoing nausea or vomiting, dark urine, swelling in the face, or jaundice (yellowing of the skin or eyes).

Depakote can also cause serious harm to the pancreas, which may get worse quickly. Call your doctor at once if you have symptoms such as: severe pain in your upper stomach spreading to your back, or ongoing nausea or vomiting.

Before taking Depakote

You should not use Depakote if you are allergic to divalproex sodium, or if you have:

  • liver disease;

  • a urea cycle disorder; or

  • a genetic mitochondrial (MYE-toe-KON-dree-al) disorder such as Alpers' disease or Alpers-Huttenlocher syndrome, especially in a child younger than 2 years old.

Depakote can cause liver failure that may be fatal, especially in children under age 2 and in people with liver problems caused by a genetic mitochondrial disorder.

If you take Depakote to prevent migraine headaches: FDA pregnancy category X. Do not use this medicine to prevent migraine headaches if you are pregnant.

To make sure this medicine is safe for you, tell your doctor if you have:

  • liver problems caused by a genetic mitochondrial disorder;

  • a history of depression, mental illness, or suicidal thoughts or actions;

  • a family history of a urea cycle disorder or infant deaths with unknown cause; or

  • HIV or CMV (cytomegalovirus) infection.

Some young people have thoughts about suicide when first taking Depakote. Your doctor will need to check your progress at regular visits while you are using this medicine. Your family or other caregivers should also be alert to changes in your mood or symptoms.

If you take Depakote for seizures or manic episodes: FDA pregnancy category D. Do not start or stop taking the medicine during pregnancy without your doctor's advice. Depakote can harm an unborn baby or cause birth defects, and may affect cognitive ability (reasoning, intelligence, problem-solving) later in the child's life. However, having a seizure during pregnancy could harm both the mother and the baby.

Use effective birth control while using Depakote, and tell your doctor right away if you become pregnant.

Seizure control is very important during pregnancy. The benefit of preventing seizures may outweigh any risks posed by taking Depakote. There may be other seizure medications that can be more safely used during pregnancy. Follow your doctor's instructions about taking this medicine while you are pregnant.

Divalproex sodium can pass into breast milk and may harm a nursing baby. Tell your doctor if you are breast-feeding a baby.

How should I take Depakote?

Take Depakote exactly as prescribed by your doctor. Follow all directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results. Do not take this medicine in larger or smaller amounts or for longer than recommended.

Drink plenty of water while you are taking this medication. Your dose may need to be changed if you do not get enough fluids each day.

You may open the Depakote sprinkle capsule and sprinkle the medicine into a spoonful of pudding or applesauce to make swallowing easier. Swallow this mixture right away.

Do not crush, chew, break, or open a delayed-release or extended-release tablet or capsule. Swallow it whole.

While using Depakote, you may need frequent blood tests.

Wear a medical alert tag or carry an ID card stating that you take Depakote. Any doctor, dentist, or emergency medical care provider who treats you should know that you are taking a seizure medication.

Do not stop using Depakote suddenly, even if you feel fine. Stopping suddenly may cause a serious, life-threatening type of seizure. Follow your doctor's instructions about tapering your dose.

Store at room temperature away from moisture and heat.

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

What should I avoid while taking Depakote?

Drinking alcohol may increase certain side effects of Depakote.

Depakote may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert.

Avoid exposure to sunlight or tanning beds. Divalproex sodium can make you sunburn more easily. Wear protective clothing and use sunscreen (SPF 30 or higher) when you are outdoors.

Depakote side effects

Get emergency medical help if you have any of these signs of an allergic reaction: to Depakote hives; fever, swollen glands, mouth sores, difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if the person taking this medicine has early signs of liver damage, such as: loss of appetite, upper stomach pain, ongoing nausea or vomiting, dark urine, swelling in the face, or jaundice (yellowing of the skin or eyes).

Depakote can also cause serious harm to the pancreas, which may get worse quickly. Call your doctor at once if you have symptoms such as: severe pain in your upper stomach spreading to your back, or ongoing nausea or vomiting.

Report any new or worsening symptoms to your doctor, such as: mood or behavior changes, depression, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), or have thoughts about suicide or hurting yourself.

Call your doctor at once if you have any of these other side effects:

  • confusion, tiredness, cold feeling, vomiting, change in your mental state;

  • easy bruising, unusual bleeding (nose, mouth, or gums), purple or red pinpoint spots under your skin;

  • severe drowsiness;

  • worsening seizures; or

  • severe skin reaction -- fever, sore throat, swelling in your face or tongue, burning in your eyes, skin pain, followed by a red or purple skin rash that spreads (especially in the face or upper body) and causes blistering and peeling.

Common Depakote side effects may include:

  • mild nausea or vomiting, mild stomach pain, diarrhea;

  • headache, mild dizziness, weakness, tremors;

  • problems with balance or walking;

  • blurred vision, double vision; or

  • changes in appetite, weight gain.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect Depakote?

Other drugs may interact with Depakote, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell each of your health care providers about all medicines you use now and any medicine you start or stop using.

For the Consumer

Applies to divalproex sodium: oral capsule delayed release, oral syrup, oral tablet delayed release, oral tablet enteric coated, oral tablet extended release

Along with its needed effects, divalproex sodium (the active ingredient contained in Depakote) may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur while taking divalproex sodium:

More common
  • Black, tarry stools
  • bleeding gums
  • bloating or swelling of the face, arms, hands, lower legs, or feet
  • blood in the urine or stools
  • confusion
  • cough or hoarseness
  • crying
  • delusions
  • dementia
  • depersonalization
  • diarrhea
  • difficult or labored breathing
  • dysphoria
  • euphoria
  • fever or chills
  • general feeling of discomfort or illness
  • headache
  • joint pain
  • loss of appetite
  • lower back or side pain
  • mental depression
  • muscle aches and pains
  • nausea
  • nervousness
  • painful or difficult urination
  • paranoia
  • pinpoint red spots on the skin
  • quick to react or overreact emotionally
  • rapid weight gain
  • rapidly changing moods
  • runny nose
  • shakiness in the legs, arms, hands, or feet
  • shivering
  • sleepiness or unusual drowsiness
  • sore throat
  • sweating
  • tightness in the chest
  • tingling of the hands or feet
  • trembling or shaking of the hands or feet
  • trouble sleeping
  • unusual bleeding or bruising
  • unusual tiredness or weakness
  • unusual weight gain or loss
  • vomiting
Less common
  • Abnormal dreams
  • absence of or decrease in body movement
  • anxiety
  • bloody nose
  • blurred vision
  • bruising burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
  • change in personality
  • change in walking and balance
  • changes in patterns and rhythms of speech
  • chest pain
  • chills
  • cloudy urine
  • clumsiness or unsteadiness
  • cold sweats
  • constipation
  • darkened urine
  • degenerative disease of the joint
  • difficulty with moving
  • dizziness
  • dizziness, faintness, or lightheadedness when getting up from a lying or sitting position suddenly
  • dry mouth
  • excessive muscle tone
  • fast, irregular, pounding, or racing heartbeat or pulse
  • fear
  • feeling of warmth or heat
  • flushing or redness of the skin, especially on the face and neck
  • frequent urge to urinate
  • heavy non-menstrual vaginal bleeding
  • hyperventilation
  • increased need to urinate
  • indigestion
  • lack of coordination
  • large, flat, blue, or purplish patches in the skin
  • leg cramps
  • lip smacking or puckering
  • loss of bladder control
  • loss of strength or energy
  • multiple swollen and inflamed skin lesions
  • muscle pain or stiffness
  • muscle tension or tightness
  • normal menstrual bleeding occurring earlier, possibly lasting longer than expected
  • pains in the stomach, side, or abdomen, possibly radiating to the back
  • passing urine more often
  • pounding in the ears
  • puffing of the cheeks
  • rapid or worm-like movements of the tongue
  • rapid weight gain
  • restlessness
  • seeing, hearing, or feeling things that are not there
  • shakiness and unsteady walk
  • slurred speech
  • small red or purple spots on the skin
  • sweating
  • swollen joints
  • trouble with speaking
  • twitching
  • uncontrolled chewing movements
  • uncontrolled movements of the arms and legs
  • unsteadiness, trembling, or other problems with muscle control or coordination
  • vomiting of blood or material that looks like coffee grounds
  • yellow eyes or skin

Get emergency help immediately if any of the following symptoms of overdose occur while taking divalproex sodium:

Symptoms of overdose
  • Change in consciousness
  • fainting
  • loss of consciousness
  • slow or irregular heartbeat

Some side effects of divalproex sodium may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common
  • Acid or sour stomach
  • belching
  • body aches or pain
  • change in vision
  • congestion
  • continuing ringing or buzzing or other unexplained noise in the ears
  • hair loss or thinning of the hair
  • hearing loss
  • heartburn
  • impaired vision
  • lack or loss of strength
  • loss of memory
  • problems with memory
  • rash
  • seeing double
  • tender, swollen glands in the neck
  • trouble with swallowing
  • uncontrolled eye movements
  • voice changes
  • weight gain
  • weight loss
Less common
  • Absent, missed, or irregular menstrual periods
  • back pain
  • burning, dry, or itching eyes
  • change in taste or bad unusual or unpleasant (after) taste
  • coin-shaped lesions on the skin
  • cough producing mucus
  • cramps
  • dandruff
  • discharge or excessive tearing
  • dry skin
  • earache
  • excess air or gas in the stomach or intestines
  • eye pain
  • feeling of constant movement of self or surroundings
  • full feeling
  • heavy bleeding
  • increased appetite
  • itching of the vagina or genital area
  • itching skin
  • loss of bowel control
  • neck pain
  • oily skin
  • pain
  • pain during sexual intercourse
  • pain or tenderness around the eyes and cheekbones
  • passing gas
  • rash with flat lesions or small raised lesions on the skin
  • redness or swelling in the ear
  • redness, pain, swelling of the eye, eyelid, or inner lining of the eyelid
  • redness, swelling, or soreness of the tongue
  • sensation of spinning
  • sneezing
  • stiff neck
  • stopping of menstrual bleeding
  • thick, white vaginal discharge with no odor or with a mild odor

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Applies to divalproex sodium: oral delayed release capsule, oral delayed release tablet, oral tablet extended release

Gastrointestinal

Nausea, vomiting, and indigestion appear less frequently and less severely with divalproex sodium (the active ingredient contained in Depakote) than with valproic acid. These effects may be further attenuated by administering doses with food.

Gastrointestinal side effects related to gastritis are common and include nausea, vomiting, and indigestion, especially with the initiation of therapy and with rapid increases in dose. These effects are generally transient and rarely require the discontinuation of therapy. Life threatening pancreatitis has been reported to occur anywhere from shortly after initial use to occurring after several years of use. Some of the cases have been described as hemorrhagic with a rapid progression from initial symptoms to death. Hyperamylasemia occurs in up to 20% of patients and rarely presents as clinical pancreatitis (usually one to six months after initiation of therapy).

Hepatic

Hepatic side effects including transient dose-dependent elevations of serum transaminases, amylase, and ammonia have been reported to occur in up to 44% of treated patients. Mild elevations in transaminases and amylase may be managed by dose reductions. Dose-related hepatitis, which is occasionally fatal, has also been reported. Some clinicians recommend monitoring liver function tests at baseline, then monthly during the first 6 months of therapy and every 3 months thereafter. Prompt withdrawal of divalproex sodium (the active ingredient contained in Depakote) is recommended if significant hepatic dysfunction occurs.

Risk factors for valproate-associated hepatitis are young age (particularly age less than 2 years old), poor nutritional status, mental retardation, underlying metabolic disease, and concomitant use of other anticonvulsant medications. Characteristic pathological features include microvesicular steatosis.

Nervous system

Nervous system side effects including drowsiness, ataxia, and hand tremor have been reported. Cases of encephalopathy (manifested by stupor, coma, hallucinations or affective changes) and chorea have been reported. Reversible sensorineural hearing loss associated with valproate therapy has been reported rarely. Two cases of extrapyramidal disorders have been reported in association with valproate therapy. A case of pseudotumor cerebri has also been reported.

Divalproex sodium may inhibit urea synthesis resulting in hyperammonemia, which has been associated with encephalopathy, delirium, and ataxia in rare cases.

Loss of seizure control may indicate associated hepatitis.

Hematologic

Some clinicians recommend monitoring complete blood counts (including platelet counts) at baseline, then monthly for three months, and every three months thereafter.

Data from a study of 265 patients strongly suggests a causal relationship between rising plasma valproic acid levels and reduced platelet counts, with additional risk factors including female gender and lower baseline platelet counts.

Hematologic side effects including rare cases of reversible thrombocytopenia associated with antiplatelet antibodies and bone marrow suppression have been reported.

Respiratory

Respiratory side effects including a case of truncal weakness and respiratory failure has been associated with valproate therapy.

Renal

Renal side effects including several case reports which suggested that valproate acid may cause Fanconi's syndrome have been reported. Valproate-induced Fanconi's syndrome has been reported more often in children than in adults.

Cardiovascular

Cardiovascular side effects including vasodilation and peripheral edema have been reported.

Endocrine

Endocrine side effects including a variety of adverse reproductive endocrine disorders have been reported in epileptic women taking valproic acid.

Valproate therapy has been associated with polycystic ovaries, elevated serum testosterone concentrations and menstrual disturbance. One study has suggested that 80% of women treated with valproic acid before the age of 20 have polycystic ovaries or hyperandrogenism.

Dermatologic

Dermatologic side effects including transient alopecia and rare rashes have been reported.

Valproate therapy has been associated with stomatitis and cutaneous leukoclastic vasculitis. A case of psoriasiform eruption has been reported in a patient receiving valproic acid.

Musculoskeletal

Musculoskeletal side effects including a case of osteopenia have been reported.

General

General side effects including hypothermia have been reported.