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Valproic Acid and Derivatives (val PROE ik AS id & dah RIV ah tives)

Brand names


US: Depacon, Depakene, Depakote, Depakote ER, Depakote Sprinkles, Stavzor
CAN: Apo-Divalproex, Apo-Valproic, Depakene, Dom-Divalproex, Dom-Valproic Acid, Dom-Valproic Acid E.C., Epival, Epival ECT, Mylan-Divalproex, Mylan-Valproic, Novo-Divalproex, Novo-Valproic, PHL-Divalproex, PHL-Valproic Acid, PHL-Valproic Acid E.C., PMS-Divalproex, PMS-Valproic Acid, PMS-Valproic Acid E.C., ratio-Valproic, Sandoz-Valproic, Teva Divalproex
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Forms of this drug

Valproate (Injectable)

Valproate (Oral Liquid)

Valproate (Oral Pill)

Valproate XR (Oral Pill)

Prescrire drugs to avoid

None

Anticholinergic burden

Score: 0

Beers criteria for older adults

None

Screening tool of older people's prescriptions (STOPP)

None

Black box warning

See product data sheet for complete boxed warning.

WARNING: LIFE THREATENING ADVERSE REACTIONS: Hepatotoxicity - Hepatic failure resulting in fatalities has occurred in patients receiving valproate. Children under the age of two years are at a considerably increased risk of developing fatal hepatotoxicity, especially those on multiple anticonvulsants, those with congenital metabolic disorders, those with severe seizure disorders accompanied by mental retardation, and those with organic brain disease. When valproic acid capsules are used in this patient group, they should be used with extreme caution and as a sole agent. The benefits of therapy should be weighed against the risks. The incidence of fatal hepatotoxicity decreases considerably in progressively older patient groups. These incidents usually have occurred during the first six months of treatment. Serious or fatal hepatotoxicity may be preceded by non-specific symptoms such as malaise, weakness, lethargy, facial edema, anorexia, and vomiting. In patients with epilepsy, a loss of seizure control may also occur. Patients should be monitored closely for appearance of these symptoms. Liver function tests should be performed prior to therapy and at frequent intervals thereafter, especially during the first six months. Fetal Risk - Valproate can cause major congenital malformations, particularly neural tube defects (e.g., spina bifida). Valproate should not be administered to a woman of childbearing potential unless the drug is essential to the management of her medical condition. This is especially important when valproate use is considered for a condition not usually associated with permanent injury or death (e.g., migraine). Women should use effective contraception while using valproate. Pancreatitis - Cases of life-threatening pancreatitis have been reported in both children and adults receiving valproate. Some of the cases have been described as hemorrhagic with a rapid progression from initial symptoms to death. Cases have been reported shortly after initial use as well as after several years of use. Patients and guardians should be warned that abdominal pain, nausea, vomiting, and/or anorexia can be symptoms of pancreatitis that require prompt medical evaluation. If pancreatitis is diagnosed, valproate should ordinarily be discontinued. Alternative treatment for the underlying medical condition should be initiated as clinically indicated.

QT Interval

None

Serotonin syndrome

Increased risk of serotonin syndrome

Product data sheet

Depakene - Packager: AbbVie

Depakote ER - Packager: AbbVie

DEPAKOTE - Packager: AbbVie

Side effects reported

Side effect Reports PRR