Depakene (Valproic Acid) and Depakote (Divalproex Sodium)
Depakene and Depakote are closely related drugs used for the treatment of petit mal, grand mal, mixed and akinetic-myoclonic seizures. (For convenience, we will refer to Depakene in the remainder of this information sheet, however, the drugs are interchangable except where noted).
- Depakene is available in the following formulations:
- 250 mg/5 ml liquid suspension
- 250 mg capsule
- Depakote is available in the following formulations:
- 125 mg sprinkles
- 250 mg tablets
- 500 mg delayed-release tablet
The usual dosage of Depakene is 1-15 mg/kilogram of body weight per day and may be increased to 30 mg/kilogram of body weight per day. Depakene is usually taken two to three times a day. The manufacturer of Depakene Syrup does not recommend mixing the syrup with carbonated beverages as it can worsen the taste of the syrup.
Therapeutic Drug Levels
The blood level of Depakene that is shown to prevent seizures in most people is between 50-100 µg/ml.
All drugs have side effects. Children taking Depakene may experience stomachache, nausea, vomiting, diarrhea, or an increase or decrease in appetite. The most common side effects are nausea and vomiting. These effects will disappear with lowering of the dose or discontinuation of the drug. At higher doses, other problems can include drowsiness, poor coordination, dizziness or double vision. These complaints are usually temporary and do not necessarily mean the drug must be stopped. Loss of hair and a skin rash have been described, but are rare.
Toxic symptoms are symptoms experienced when the blood Depakene level is too high. Toxic symptoms include excessive drowsiness, unsteadiness or slurred speech. If your child experiences these symptoms you should call your neurologist. Depakene often leads to a mild increase in liver enzymes in the blood. This usually does not need any treatment.
Rarely, Depakene produces an allergic--like reaction in the liver that is quite serious. Signs of this include profound lethargy and/or repeated vomiting. This reaction is unpredictable and usually occurs shortly after the drug is started. Liver enzymes should be checked before Depakene is started to ensure that the liver is healthy. On rare occasions, Depakene can decrease the white blood cells and platelets. These cells fight infection and clot blood. For these reasons, children taking Depakene should have periodic blood counts (CBC) and liver function tests.
Scheduled monitoring of liver enzymes, blood cell counts and Depakene levels have increased the safety and efficacy of Depakene. The frequency of checking these values is variable and determined by several factors. However, usually in children taking Depakene, we will obtain a Depakene level about 4 weeks after reaching a therapeutic dose, and then every 4-12 months thereafter. We will also obtain a complete blood count (CBC) often before starting the drug and then every 4-12 months thereafter. Liver function tests (AST or ALT) are also usually obtained before starting the drug and then often monthly for 3 months, then every 4-12 months thereafter
Depakene may interact with other drugs, including other antiepileptic drugs. Phenobarbital, Dilantin (Phenytoin), Tegretol (Carbamazepine) and Lamictal can decrease the Depakene blood level. The blood levels of other antiepileptic drugs can also be affected by Depakene. When used in combination with Depakene, the levels of Phenobarbital, Felbatol or Lamictal can increase. Inform your neurologist if your child is taking any other medications. Also your local pharmacist can often be helpful in informing you of known drug interactions between the medications your child takes.
Shelly Flynn, RN, MA, CPNP and Pediatric Neurology Staff