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divalproex sodium (valproate)
Depakote (DR) · Depakote ER · Depakene (valproic acid) · Depacon (IV valproate)
Mood stabilizer⚠ Unverified beta content
At a glance
- Class
- Anticonvulsant mood stabilizer
- Black box
- ⚠ Hepatotoxicity, including fatal liver failure (highest risk
- ⚠ Fetal risk
- ⚠ Pancreatitis, including hemorrhagic cases with rapid progression and fatalities.
- Key monitoring
- Serum valproate level — 50–125 mcg/mL (mania, trough)
- LFTs (AST/ALT, bilirubin)
- Usual adult dose
- Mania (DR): Start 750 mg/day in divided doses; titrate to clinical effect; max 60 mg/kg/day
- Call provider / escalate if
- Yellow skin or eyes, dark urine, severe fatigue, loss of appetite • Severe abdominal pain, nausea, vomiting (pancreatitis) • New confusion, lethargy, hypothermia (hyperammonemia)
Built-in explanation — generated offline from this app’s structured data (no AI, no network). Still unverified beta content.
What it is
- divalproex sodium (valproate) (Depakote (DR), Depakote ER, Depakene (valproic acid)) — anticonvulsant mood stabilizer.
- Used for: Acute manic or mixed episodes; Epilepsy; Migraine prophylaxis.
Usual adult dosing
- Mania (DR): Start 750 mg/day in divided doses; titrate to clinical effect; max 60 mg/kg/day (Therapeutic trough levels generally 50–125 mcg/mL.)
- Mania (ER): Start 25 mg/kg/day once daily; max 60 mg/kg/day
- Serum level target: 50–125 mcg/mL (mania; trough) (Total valproate level; free level may be needed if low albumin.)
Boxed warning
- Hepatotoxicity, including fatal liver failure (highest risk: first 6 months, children <2 yrs, mitochondrial disease).
- Fetal risk: major congenital malformations (neural tube defects), decreased IQ scores and neurodevelopmental disorders – avoid in pregnancy unless no alternative; contraception counseling is essential.
- Pancreatitis, including hemorrhagic cases with rapid progression and fatalities.
Monitor
- Serum valproate level — 50–125 mcg/mL (mania, trough) [After titration/steady state (~3–5 days), then periodically]
- LFTs (AST/ALT, bilirubin) [Baseline; frequently in first 6 months (e.g., q2–4 wks initially), then periodically]
Nursing priorities
- Baseline LFTs, CBC with platelets, pregnancy test (and contraception plan), weight/BMI.
- Assess for liver symptoms (jaundice, dark urine, anorexia) and abdominal pain.
- Draw trough level just before the next dose.
- Swallow DR/ER tablets whole; do not crush.
- Give with food for GI upset.
Major interactions
- Lamotrigine: Valproate roughly doubles lamotrigine levels → lower lamotrigine dose; ↑ risk of serious rash.
- Carbapenem antibiotics (meropenem, etc.): Markedly lower valproate levels – avoid combination.
Key teaching
- Take it with food and swallow whole. Do not stop suddenly.
- You will need regular blood tests for drug level, liver, and platelets.
- This medicine can seriously harm an unborn baby. Tell your provider right away if you could become pregnant; use reliable birth control.
Optional: AI explanation
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Boxed warning
- Hepatotoxicity, including fatal liver failure (highest risk: first 6 months, children <2 yrs, mitochondrial disease).
- Fetal risk: major congenital malformations (neural tube defects), decreased IQ scores and neurodevelopmental disorders – avoid in pregnancy unless no alternative; contraception counseling is essential.
- Pancreatitis, including hemorrhagic cases with rapid progression and fatalities.
Other serious warnings
- Hyperammonemic encephalopathy (with or without elevated LFTs)
- Thrombocytopenia / bleeding
- Hypothermia
- Multi-organ hypersensitivity (DRESS)
- Suicidality (antiepileptic class warning)
- Polycystic ovary syndrome-like effects
- Do not abruptly stop (seizures)
Sources: FDA label (DailyMed): DEPAKOTE (DIVALPROEX SODIUM) TABLET, DELAYED REL
- Serum valproate levelTarget: 50–125 mcg/mL (mania, trough)When: After titration/steady state (~3–5 days), then periodically
- LFTs (AST/ALT, bilirubin)When: Baseline; frequently in first 6 months (e.g., q2–4 wks initially), then periodically
- CBC with plateletsWhen: Baseline and periodically; before surgery
- AmmoniaIf unexplained lethargy, vomiting, confusion
- Weight / metabolic parameters
- Pregnancy status
Sources: FDA label (DailyMed): DEPAKOTE (DIVALPROEX SODIUM) TABLET, DELAYED REL
Assessment
- Baseline LFTs, CBC with platelets, pregnancy test (and contraception plan), weight/BMI.
- Assess for liver symptoms (jaundice, dark urine, anorexia) and abdominal pain.
- Mental status, sedation, tremor, gait.
- Bruising or bleeding.
Interventions
- Draw trough level just before the next dose.
- Swallow DR/ER tablets whole; do not crush.
- Give with food for GI upset.
- Notify provider for severe abdominal pain/vomiting (pancreatitis) or new confusion/lethargy (check ammonia).
- Reinforce reliable contraception in people who can become pregnant.
Sources: General nursing drug reference conventions (e.g., Davis Drug Guide / L
- Yellow skin or eyes, dark urine, severe fatigue, loss of appetite
- Severe abdominal pain, nausea, vomiting (pancreatitis)
- New confusion, lethargy, hypothermia (hyperammonemia)
- Unusual bruising, nosebleeds, bleeding gums
- Seizure or worsening seizures
- Rash, fever, swollen glands
- Suicidal thoughts
- Pregnancy
Sources: FDA label (DailyMed): DEPAKOTE (DIVALPROEX SODIUM) TABLET, DELAYED REL · General nursing drug reference conventions (e.g., Davis Drug Guide / L
- Nausea, vomiting, indigestion
- Sedation, dizziness
- Tremor
- Weight gain, increased appetite
- Hair thinning / hair loss
- Thrombocytopenia (dose-related)
- Elevated liver enzymes
Sources: FDA label (DailyMed): DEPAKOTE (DIVALPROEX SODIUM) TABLET, DELAYED REL
- Lamotrigine MajorValproate roughly doubles lamotrigine levels → lower lamotrigine dose; ↑ risk of serious rash.
- Carbapenem antibiotics (meropenem, etc.) MajorMarkedly lower valproate levels – avoid combination.
- Aspirin, warfarinDisplaces protein binding / bleeding risk.
- Phenobarbital, phenytoin, carbamazepineAltered levels of both drugs.
- TopiramateHyperammonemia, hypothermia, encephalopathy risk.
- Alcohol, other CNS depressantsAdditive sedation.
Sources: FDA label (DailyMed): DEPAKOTE (DIVALPROEX SODIUM) TABLET, DELAYED REL
- Take it with food and swallow whole. Do not stop suddenly.
- You will need regular blood tests for drug level, liver, and platelets.
- This medicine can seriously harm an unborn baby. Tell your provider right away if you could become pregnant; use reliable birth control.
- Call right away for yellow skin/eyes, dark urine, severe belly pain, or repeated vomiting.
- Tell all providers you take it before any surgery; report easy bruising or bleeding.
- It may cause weight gain, shaking, hair thinning, and sleepiness.
Sources: General nursing drug reference conventions (e.g., Davis Drug Guide / L
Indications
- Acute manic or mixed episodes (bipolar disorder)
- Epilepsy (complex partial / absence seizures)
- Migraine prophylaxis
Dosing
- Mania (DR): Start 750 mg/day in divided doses; titrate to clinical effect; max 60 mg/kg/dayTherapeutic trough levels generally 50–125 mcg/mL.
- Mania (ER): Start 25 mg/kg/day once daily; max 60 mg/kg/day
- Serum level target: 50–125 mcg/mL (mania; trough)Total valproate level; free level may be needed if low albumin.
Sources: FDA label (DailyMed): DEPAKOTE (DIVALPROEX SODIUM) TABLET, DELAYED REL
Prescriber-oriented details; limited in this beta.
titration
- Mania: start 750 mg/day divided (DR) or 25 mg/kg/day ER; increase rapidly to response/level.
hepatic Adjustment
- Contraindicated in significant hepatic disease/dysfunction.
pregnancy Lactation
- Boxed warning for neural tube defects and neurodevelopmental effects; contraindicated for migraine prophylaxis in pregnancy.
cyp Notes
- Inhibits UGT and some CYP2C9; protein-binding displacement.
Sources: FDA label (DailyMed): DEPAKOTE (DIVALPROEX SODIUM) TABLET, DELAYED REL
- Verified
- No – unverified beta
- Last reviewed
- 2026-10-29 (drafted; not clinician-reviewed)
- FDA label (DailyMed): DEPAKOTE (DIVALPROEX SODIUM) TABLET, DELAYED RELEASE [ABBVIE INC.]
- General nursing drug reference conventions (e.g., Davis Drug Guide / Lexicomp nursing) - summarized from standard practice; NOT line-by-line verified
Reviewer notes – please double-check
- Level reference ranges differ by indication (epilepsy 50–100; mania up to 125) – verify against facility/lab policy.