Home Drug Guide Divalproex Sodium

Drug Guide

Generic Name

Divalproex Sodium

Brand Names Depakote, Depakote Cp, Depakote Er

Classification

Therapeutic: Anticonvulsant, Mood Stabilizer

Pharmacological: Prodrug of Valproic Acid, histone deacetylase inhibitor

FDA Approved Indications

Treatment of epilepsy (partial, generalized, and absence seizures)
Manic episodes associated with bipolar disorder
Prophylaxis of migraine headaches

Mechanism of Action

Divalproex Sodium increases gamma-aminobutyric acid (GABA) levels in the brain by inhibiting GABA transaminase and promoting GABA synthesis, leading to stabilization of neuronal activity.

Dosage and Administration

Adult: Initial dose typically 250 mg 2-3 times daily, titrated up to maintenance dose of 750-2000 mg/day in divided doses.

Pediatric: Starting dose varies based on age and weight; typically 15 mg/kg/day divided in 2-3 doses, titrated gradually.

Geriatric: Use with caution; start at lower doses due to increased risk of side effects.

Renal Impairment: Adjust dose as needed; monitor renal function.

Hepatic Impairment: Use with caution; monitor liver function closely.

Pharmacokinetics

Absorption: Well absorbed orally, food may delay absorption.

Distribution: Widely distributed in body tissues with approximately 90% plasma protein binding.

Metabolism: Primarily hepatic via glucuronidation and beta-oxidation; minimal CYP450 involvement.

Excretion: Renally excreted as metabolites; less than 10% excreted unchanged.

Half Life: Approximately 9-16 hours.

Contraindications

Hypersensitivity to divalproex or valproic acid
Liver disease
Urea cycle disorders

Precautions

History of pancreatitis
Blood dyscrasias
Pregnancy Risks (see special considerations)
Monitor liver function and blood counts regularly

Adverse Reactions - Common

nausea (common)
drowsiness (common)
tremor (common)
weight gain (common)

Adverse Reactions - Serious

hepatotoxicity (rare)
pancreatitis (rare)
thrombocytopenia (rare)
Neural Tube Defects in pregnancy (rare (see pregnancy considerations))

Drug-Drug Interactions

CNS depressants (additive sedation)
Carbapenem antibiotics (risk of decreased levels)
Other hepatotoxic drugs

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor liver function tests, CBC, serum drug levels, and neurological status.

Diagnoses:

Risk for injury related to sedation or tremors
Risk for hepatotoxicity

Implementation: Administer with food to minimize GI upset. Titrate dose gradually.

Evaluation: Assess seizure control, mood stabilization, and adverse effects regularly.

Patient/Family Teaching

Take medication exactly as prescribed.
Report signs of liver dysfunction (jaundice, abdominal pain), pancreatitis (abdominal pain, nausea), or unusual bleeding.
Avoid alcohol and CNS depressants.
Consult provider before pregnancy; discuss risks.

Special Considerations

Black Box Warnings:

Hepatotoxicity, especially in children under 2 years old
Impaired cognitive development and neural tube defects in pregnancy

Genetic Factors: Genetic variations may affect drug metabolism and toxicity.

Lab Test Interference: May interfere with certain blood tests; interpret labs accordingly.

Overdose Management

Signs/Symptoms: Somnolence, CV depression, hyperactivity, blurred vision, nystagmus, coma.

Treatment: Supportive care; activated charcoal if ingestion is recent; hemodialysis in severe cases; monitor vital signs and neurological status.

Storage and Handling

Storage: Store at room temperature, 15-30°C, away from moisture, heat, and light.

Stability: Stability varies; refer to manufacturer specifications.