Abbott, market exclusivity expires 2008; Depakene is available as a generic
Acute Mania (only Depakote ER is officially approved for this)
Off-Label use for Prevention of Depression and Mania in Bipolar Disorder
Off-label use for treating various problems related to impulsivity and rage
Unknown, may work by increasing GABA (gamma-aminobutyric acid)
Most clinicians dose Depakote at bedtime in order to increase compliance and minimize side effects, regardless of the formulation used.
Start at 250-500 mg QHS, gradually increasing to achieve a blood Depakote level of 70-80 mcg/mL, which will often be in the 1000-1250 mg QHS range.
When converting from regular Depakote to Depakote ER, be aware that patients will see about 20% less valproic acid with the ER formulation, making converting somewhat tricky, given that Depakote ER only comes in the 500 mg option.
The dose of Depakote should be decreased in both liver disease and renal impairment.
Most common: nausea (switch to Depakote ER or Depakote sprinkles), fatigue, dizziness, tremor (treat with Inderal LA 60 mg QAM or regular Inderal 20 mg BID-TID)
Thrombocytopenia (slight lowering of platelets not uncommon; significant problems more likely in elderly)
Elevated liver function tests (not uncommon, usually benign, but need to monitor for very rare hepatic failure)
Polycystic ovarian syndrome (PCOS) in about 10% of women (irregular periods, hirsutism, elevated testosterone)
Black box warnings: Hepatotoxicity (rare, more likely to occur in young children), pancreatitis (also quite rare).
Pregnancy Category D (high rate of neural tube defects)
Increases Lamictal levels; aspirin increases Depakote levels; combination with topiramate can lead to encephalopathy