Divalproex sodium and valproic acid
Divalproex sodium and valproic acid are comparable medications. Valproic acid is modified to create divalproex sodium. Even so, these Although they are most typically used as anticonvulsants, or to treat seizures, they may also be used to treat other illnesses. The United States has authorized Stavzor, Divalproex sodium, and Divalproex sodium ER in addition to treating seizures.
Food and Drug Administration (FDA) for the management of bipolar disorder-related manic episodes; Divalproex sodium ER has indications for the prevention of migraine headaches. When Stavzor, Divalproex sodium, and Divalproex sodium ER, sometimes referred to as mood stabilizers, are used to treat bipolar illness.
The active ingredient in divalproex sodium is valproic acid; however, there are other dosage formulations available. The body transforms each of the several preparations into valproic acid. The only forms of immediate-release valproic acid that are available in generic form are 250 mg gel capsules and liquid under the trade name Depakene. The delayed-release version of valproic acid is called Stavzor. Valproic acid comes in two formulations: Divalproex sodium and Divalproex sodium ER, which provide prolonged and delayed activity, respectively.
SUBTILIZERS OF MOOD
Tablets of Divalproex sodium may be taken twice a day. Divalproex sodium Sprinkle capsules containing divalproex sodium may also be opened and sprinkled over meals. Extended-release Divalproex sodium ER pills are meant to be used once daily.
According to clinical research, lithium and valproic acid are equally useful in treating acute manic episodes and avoiding a bipolar disorder recurrence. When treating rapid-cycling bipolar disorder and mixed episodes, which are characterized by both mania and depression coexisting in the same episode, valproic acid is more successful.
(when an individual goes through four manic or severe depression episodes or more in a year). Since Divalproex sodium ER and stavzor are less toxic and better tolerated than lithium, they are often used for the treatment of bipolar disorder.
For convenience, the brand term Divalproex sodium is used to refer to all valproic acid formulations in this presentation; nevertheless, the material also applies to the other valproic acid derivatives.
Information about Dosing
Divalproex sodium is often started at 500 mg twice day for the treatment of acute mania. The dose is then increased by 250 mg/day every three to four days until a therapeutic level is attained. Typically, a daily dose of 1,000–3,000 mg is needed to treat acute manic episodes. With Divalproex sodium ER, the dosage of Divalproex sodium may be changed to once daily.
For acute mania, the dosage for Stavzor is comparable to that of Divalproex sodium. It is advised to begin with 750 mg per day, split into two dosages. In order to control symptoms, the dose is raised as quickly as necessary.
Typical Side Effects
Divalproex sodium ‘s most frequent adverse effects are fatigue, drowsiness, and gastrointestinal problems such cramps, diarrhea, and nausea. Changing the dose completely or mostly close to sleep may reduce daytime sedation. Compared to Depakene capsules or syrup, enteric-coated tablets of Divalproex sodium and Divalproex sodium ER are linked to less gastrointestinal adverse effects.
Individuals using Divalproex sodium may develop ataxia, or clumsiness while walking, as well as tremor and poor coordination. These adverse effects usually pass quickly when a patient becomes used to the drug. When using Divalproex sodium, people may have alopecia, or hair loss. This condition may be brought on by the medicine interfering with the body’s ability to absorb zinc and selenium. Taking zinc-containing elements in a daily multivitamin, Selenium might halt and possibly prevent hair loss. Divalproex sodium may cause a noticeable increase in weight. To manage their weight, Divalproex sodium users should exercise often and eat a balanced diet.
Adverse Events and Safety Measures
Divalproex sodium may make you sleepy and less attentive, particularly in the beginning of your treatment. Patients who drive or undertake other duties requiring awareness should use care.
The FDA mandated that manufacturers include a strong warning about possible liver damage in its labeling requirements for Divalproex sodium due to reports of liver failure in individuals using the medication. It seems that toddlers under the age of two are most at danger, and that risk drastically decreases as individuals become older. It is hard to forecast when liver damage may manifest, hence liver function tests should be performed both before to therapy and every six months after that. While liver toxicity is uncommon, patients should be informed of the possibility and urged to report any early symptoms to their doctor, such as fatigue, nausea, lack of appetite, and yellowing of the skin and eyes (jaundice).
Divalproex sodium /Divalproex sodium ER (divalproex sodium) and Depakene/Stavzor (valproic acid)
Pancreatitis is another uncommon side effect of Divalproex sodium. There have been reports of life-threatening pancreatitis in both adults and children on Divalproex sodium. These cases might happen soon after beginning treatment or years later. Severe stomach discomfort, lack of appetite, nausea, and vomiting are some of the early warning signs of pancreatitis. If these symptoms appear, the patient ought to get help right once.
Divalproex sodium may result in thrombocytopenia, a reduction in platelets that is often evaluated when a doctor requests a full blood count. When this syndrome arises, platelet counts often drop somewhat. Divalproex sodium may, in rare cases, dramatically reduce platelets, which might lead to bleeding and clotting problems.
Use in Breastfeeding and Pregnancy: Pregnancy Category D
There is a greater risk of spinal cord defects (spina bifida) and poor brain development in offspring of mothers who used Divalproex sodium during the first trimester of pregnancy. Women ought not to receive Divalproex sodium if they are pregnant, or if they want to become pregnant, the medicine should be stopped. But if the woman has a history of relapse, it might be more dangerous for the unborn child and mother.
Whenever Divalproex sodium is stopped in a youngster, the doctor could think about keeping the drug with the patient’s permission. Take 1 mg of folic acid, a B vitamin, daily by the pregnant woman to lower the risk of birth abnormalities caused by Divalproex sodium. Divalproex sodium use should ideally be limited to the second and third trimesters.
Divalproex sodium and other valproic acid formulations should not be used by nursing women since they are excreted in breast milk and might be dangerous if consumed by the child. Breastfeeding should not begin or should be stopped if quitting the medication is not an option.
Potential Interactions with Drugs
Divalproex sodium may decrease the metabolism of some drugs by interfering with their liver enzymes, which might raise their amounts and cause unfavorable side effects. On the other hand, Divalproex sodium ‘s metabolism is inhibited by other drugs, which raises the drug’s blood levels. The table below provides an overview of all documented clinically relevant medication interactions involving Divalproex sodium.
Cimetidine, erythromycin, and fluoxetine, phenothiazine antipsychotics (e.g., chlorpromazine), and fluvoxamine as well as nonsteroidal anti-inflammatory drugs (like aspirin and Motrin). When any of these drugs are used in conjunction with Divalproex sodium, the drug, may raise levels of Divalproex sodium by inhibiting its metabolism.- (ethosuximide), phenobarbital, (carbamazepine), (phenytoin), and rifampin, when any of these drugs are used in conjunction with Divalproex sodium, Divalproex sodium levels may drop, which would reduce Divalproex sodium ‘s efficacy.
- Lamotrigine, or Lamictal Divalproex sodium may raise Lamictal blood levels, which may raise the possibility of a potentially serious rash. Lamictal doses are raised extremely gradually when these two drugs are used together.
Warfarin, Combining Divalproex sodium with Warfarin, an anticoagulant, may exacerbate its effects and raise the risk of bleeding. - Alcohol should not be used by Divalproex sodium users as this combination may worsen sleepiness and sedation. Additionally, alcohol’s sedative properties may have a depressive impact, masking Divalproex sodium ‘s therapeutic benefits and making treatment more difficult.
Overdosing
Depending on the dosage taken as well as the person’s age and stature, a Divalproex sodium overdose may be lethal. For instance, the fatal dosage in elders is less than in younger individuals. Sleeplessness, disorientation, convulsions, heart block, and coma are among the symptoms. A Divalproex sodium overdose may result in severe respiratory depression, which, if medical attention is delayed, is often deadly.
Treating any suspected overdose as an emergency is imperative. The individual has to be brought to the emergency space for care and observation. It is advisable to include both the prescription bottle of medicine and any other medication suspected in the overdose, since the information on the label may be useful in helping the treating physician figure out how many tablets the patient has taken.
Precaution Points to Remember
• If you forget to take a dosage, catch up by taking it two to three hours later than planned. If it’s near, Skip the missed dosage and resume your usual dosing regimen for the next scheduled dose. Never take two doses at once.
• The extended-release version, Divalproex sodium ER, is meant to be taken once daily. Do not chew or crush the pills; instead, swallow them whole. Divalproex sodium should be taken with food or after meals if stomach distress develops.
• If you have chronic abdomen discomfort, nausea, vomiting, lack of appetite, or jaundice, get in touch with your doctor.
• Divalproex sodium may affect your alertness and produce sleepiness and drowsiness, particularly at the start of therapy. When driving or doing other duties that call for attentiveness, proceed with care.
• Keep the medicine out of direct sunlight and dampness, in the light-resistant container that came with it. Your drug may break down more quickly in hot and humid environments, losing its therapeutic benefits.
• Keep your medicine out of children’s reach since it may be very harmful for young children to overdose.
