Depakote 250 (Divalproex 250mg)

Depakote general information

What is Depakote used for?

Depakote tablets 250mg are used in the treatment of epilepsy in adults and children.  Epilepsy is a chronic neurological disorder that is characterized by seizures or fits of various different types that can range from mild to severe.  Depakote 250 is used to prevent seizures in primary generalised epilepsy, in which the whole brain is involved, and partial epilepsy, in which the area of the brain involved in a seizure is localised.  A local seizure may spread to become a generalised seizure which cover a range of different types of seizure, including absence seizures (previously known as petit mal), various forms of myoclonic epilepsy and tonic-clonic seizures.  Depakote 250 is also a mood stabiliser used in the treatment of bipolar disorder to control acute mania and for prophylaxis or prevention of episodes of mania.  Bipolar disorder is characterised by the extreme mood swings of mania and depression.  Depakote 250 is also used to prevent migraine headaches in adults.  Depakote tablets 250mg help treat these different conditions working through a common mechanism to relieve symptoms, and can be used alone as monotherapy or in conjunction with other anticonvulsants.  

How does Depakote work?

Depakote tablets 250mg contain divalproex, which is converted to the active metabolite valproate and is an anticonvulsant used to prevent seizures in epilepsy and also has antipsychotic properties, which are used for mood stabilising in bipolar disease.  Epileptic seizures are triggered by episodes of abnormal electrical activity in the brain, in which a malfunction in the transmission of electrical signals causes repetitive firing and transmission of excitatory nerve messages.  Transmission of electrical signals is controlled by brain chemicals called neurotransmitters and for the brain to function normally it is important to have a balance between excitatory neurotransmitters and those that have a calming effect on nerve cells.  Gamma amino-butyric acid (GABA) is an inhibitory neurotransmitter and divalproex in Depakote tablets 250mg is thought to act as an anticonvulsant by increasing the activity of GABA in the brain, either by preventing its degradation or its reuptake by neuronal cells, which has a “nerve calming” effect, thereby stabilising electrical activity in the brain.  The anticonvulsant and antipsychotic actions of divalproex in Depakote tablets 250mg are thought to be due to its GABA-ergic (potentiation of GABA) properties, which contribute to its anti-epilipeptic and anti-manic effects¹.  Divalproex in Depakote 250 is also thought to act as a nerve cell membrane stabiliser by blocking voltage-dependent sodium channels, which are involved in making nerve cells hyper-excitable, as a build-up of sodium ions is needed before a nerve cell can discharge and transmit an electrical signal¹.  These combined actions of Depakote 250 stabilise electrical activity in the brain and inhibit the repetitive firing and transmission of excitatory nerve messages, which reduces the impulses that cause seizures and manic episodes. 

What does Depakote contain?

Depakote tablets 250mg contain the active ingredient divalproex (also known as valproate semisodium a combination of equimolar sodium valproate and valproic acid) an anticonvulsant with antipsychotic properties, used to treat bibolar disorder and epilepsy.  They also contain hydrated colloidal silica, pregelatinised starch, povidone, titanium dioxide (E171), talc, hypromellose phthalate, diacetylated monoglycerides, sunset yellow aluminium lake (E110), vanillin.   

Treating epilepsy with Depakote

Depakote tablets 250mg contain divalproex, an anticonvulsant that is used to control seizures in several forms of epilepsy, ranging from partial to generalized tonic-clonic seizures.  Epilepsy is triggered by episodes of abnormal electrical activity in the brain, in which a malfunction in the transmission of electrical signals causes repetitive firing and transmission of excitatory nerve messages.  This is due to an imbalance between excitatory neurotransmitters (chemicals that allow nerve cells to communicate), and those that have a calming effect on nerve cells, which causes bursts of electrical activity in the brain resulting in a seizure.  Gamma amino-butyric acid (GABA) is an inhibitory neurotransmitter and divalproex in Depakote 250 is thought to act as an anticonvulsant by increasing the activity of GABA in the brain, which has a “nerve calming” effect thereby stabilising electrical activity in the brain.  Divalproex in Depakote 250 is also thought to act as a nerve cell membrane stabiliser by blocking voltage-dependent sodium channels, which are involved in making nerve cells hyper-excitable, as a build up of sodium ions is needed before a nerve cell can discharge and transmit an electrical signal.  These combined of actions of Depakote 250 stabilise electrical activity in the brain and inhibit the repetitive firing and transmission of excitatory nerve messages, which reduces the nerve impulses that cause seizures,

Depakote for bipolar disorder

Depakote tablets 250mg contain divalproex, which is an anticonvulsant with antipsychotic properties and is used for mood stabilising in the treatment of mania in bipolar disease; also prevention episodes of mania.  A manic episode is a part of bipolar disorder, which is characterised by the extreme moods of mania and depression.  Manic symptoms include distinct period of elevated or irritable mood, hyperactivity, mental over-activity, reduced need for sleep, inflated self-importance and increased risk taking.  Depressive symptoms include decreased energy, feelings of guilt, hopelessness, helplessness, crying, and suicidal ideations.  A manic episode is followed by periods of low mood or depression.  Episodes of mania that occur in bipolar disease are thought to be due to an imbalance between excitatory neurotransmitters (chemicals that allow nerve cells to communicate), and those that have a calming effect on nerve cells and this can cause bursts of electrical activity which results in mood instability.  Gamma amino-butyric acid (GABA) is an inhibitory neurotransmitter and divalproex in Depakote 250 is thought to act as an antipsychotic by increasing the activity of GABA in the brain, which has a “nerve calming” effect thereby stabilising electrical activity in the brain, which reduces the impulses that cause manic episodes.

What are the side effects of Depakote?

The most commonly reported side effects when taking Depakote tablets 250mg include: gastrointestinal upset (nausea, vomiting, diarrhoea abdominal cramps, changes in appetite), headache, tremor, unsteadiness when walking (ataxia), dizziness or light-headedness, depression, sedation.

When should Depakote not be used?

You should not use Depakote tablets 250mg if you:

• are allergic to divalproex or any other valproate or any ingredients in Depakote
• are pregnant or are breastfeeding
• have kidney or liver disease, severe hepatitis or a family history of hepatitis
• a urea cycle disorder or a family history of urea cycle disorders
• porphyria which is a rare blood disease of blood pigments
• are taking medicines that interact with Depakote, including other anticonvulsants like felbamate, phenytoin, lamotrigine, carbamazepine, primidone, topiramate and ethosuximide; anticoagulants including warfarin and aspirin; antipsychotic neuroleptics, chlorpromazine; antidepressants like SSRIs, TCAs, MAOIs; benzodiazepines like diazepam, lorazepam, zidovudine for HIV; Cimetidine for peptic ulcers; Cholestyramine for high cholesterol; antibiotics like rifampicin and erythromycin

What medications interact with Depakote?

Several medications interact with Depakote 250 and should either not be taken while you are taking Depakote or only after discussion and instruction from your doctor:

• Drugs that cause a serious reaction with Depakote: other anticonvulsants including  topiramate, primidone, mefloquine for malaria
• Drugs that affect Depakote: other anticonvulsants like felbamate, phenytoin and carbamazepine; aspirin to prevent blood clotting; Cimetidine for peptic ulcers; Cholestyramine for high cholesterol; antibiotics like rifampicin and erythromycin
• Drugs that are affected by Depakote: other anticonvulsants like felbamate, phenytoin, lamotrigine, carbamazepine, primidone and ethosuximide; anticoagulants including warfarin and aspirin; antipsychotic neuroleptics, chlorpromazine; antidepressants like SSRIs, TCAs, MAOIs; benzodiazepines like diazepam, lorazepam, zidovudine for HIV

How should Depakote be taken?

You should take your Depakote tablets 250mg swallowed whole with a glass of water and with food, usually twice daily.  Depakote 250 is formulated for controlled release as it passes through your intestines.  The dose you take and how often depends on what you are being treated for and your condition.  Your doctor may increase your dose to ensure that your condition is controlled.  You should continue to take Depakote 250 for as long as recommended by your doctor, which may be for long-term therapy, as it will control your condition but will not cure it.  

How long should you take Depakote?

You should continue to take Depakote 250 for as long as recommended by your doctor, which may be for long-term therapy, as it will control your condition but will not cure it.  

Missed dose of Depakote

If you miss a dose of Depakote 250 take it as soon as you remember, unless it is time to take the next dose, then skip the missed dose.  Do not take a double dose.

How should Depakote be stored?

You should store your Depakote below 25°C in a cool dry place. 

Reference

1. Stoner SC and Dahmen MM.  Extended-release divalproex in bipolar and other psychiatric disorders: A comprehensive review. Neuropsychiatr Dis Treat 2007; 3: 839–846.