PATIENT INFORMATION ON DIVALPROEX OR VALPROIC ACID

Divalproex and valproic acid are drugs, which in the body are changed into a chemical called valproate. Valproate is classified as a mood stabilizer and anticonvulsant agent.

Uses

Valproate is used primarily in the treatment of acute mania and in the long-term control or prophylaxis of Manic Depressive Illness (Bipolar Disorder). It is also used in the treatment of seizure disorders as well as migraine headaches.

Though not approved for these indications, Valproate has also been found to be useful in the augmentation of antidepressants in the treatment of depression, augmentation of narcoleptics in the treatment of schizophrenia, and in behavior disturbances, such as chronic aggression or impulsivity.

How does the doctor decide what dose (how many milligrams) to prescribe?

The dose of evaporate is different for every patient and is based on how much valproate is in blood, as well as the response to treatment. The doctor will measure the drug level in the blood during the first few months. The valproate level that is usually found to be effective for most patients is between 350 and 700 mol/L (50-100 uGu/ml).

You may initially take your medication several times a day (2 or 3); after several weeks, the doctor may decide to prescribe the drug once daily.

On the morning of your blood test, take the morning dose of valproate after the test to avoid inaccurate results.

How quickly will the drug start working?

Control of manic symptoms may require up to 14 days of treatment. Because valproate takes time to work, do not decrease or increase the dose or stop the medication without discussing this with your doctor. Improvement in seizures as well as aggression/impulsivity also occur gradually.

How long should you take this medication?

Following the first episode of mania it is recommended that valproate be continued for a minimum of one year; this decreases the chance of being ill again. The doctor may then decrease the drug slowly and monitor for any symptoms; if none occur, the drug can gradually be stopped. For individuals who have had several episodes of mania or depression, valproate should be continued indefinitely. Long-term treatment is generally recommended for recurring depression, seizure disorder and aggression/ impulsivity.

Side effects

Side effects occur, to some degree, with all medication. They are usually not serious and do not occur in all individuals. They may sometimes occur before beneficial effects of the medication are noticed. If a side effect continues, speak to your doctor about appropriate treatment.

Common side effects that should be reported to your doctor at the next appointment include:

• Drowsiness and lethargy, difficulty concentrating-This problem goes away with time. Use of other drugs that make you drowsy will worsen the problem. Avoid driving a car or operating machinery if drowsiness persists.
• Ataxia or unsteadiness, in coordination-Discuss this with your doctor as this may require an adjustment in your dosage.
• Blurred vision-This usually occurs at the start of treatment and tends to be temporary. Reading under a bright light or at a distance may help; a magnifying glass can be of temporary use. If the problem continues, advise your doctor.
• Nausea or heartburn, vomiting, mild cramps-If this happens, take the medication with food.
• Muscle tremor, shaking of the hands or arms-Speak to your doctor as this may require an adjustment in your dosage.
• Changes in hair texture, hair loss.
• Weight changes-Monitor your food intake; avoid foods with high fat content (e. g., cakes and pastry).
• Changes in the menstrual cycle.

Rare side effects you should report to your doctor IMMEDIATELY include:

• Soreness of the mouth , gums , or throat, mouth lesions
• Skin rash or itching, swelling of the face
• Nausea, vomiting, abdominal pain
• Lethargy, weakness, fever, or flu-like symptom
• Easy bruising, bleeding (e. g., frequent nose bleeds, bleeding from the gums), appearance of splotchy purplish darkening of the skin
• Yellowing of the skin or eyes, darkening of urine
• Unusual eye movements
• Severe dizziness

Let your doctor know as soon as possible if you miss your period or suspect you may be pregnant.

What should you do if you forget to take a dose of your medication?

If you take your total dose of evaporate in the morning and you forget to take it for more than 6 hours, skip the missed dose and continue with your schedule the next day. DO NOT DOUBLE THE DOSE. If you take the drug several times a day, take the missed dose when you remember, then continue with your regular schedule.

Interactions with other medication

Because valproate can change the effect of other medication, or may be affected by other medication, always check with your doctor or pharmacist before taking other drugs, including over-counter medication such as cold remedies. Always inform any doctor or dentist that you are taking this drug.

Precautions

1. Do not increase or decrease your dose without consulting your doctor.
2. This drug may impair the mental and physical abilities and reaction time required for driving a car or operating other machinery. Avoid these activities if you feel drowsy or slowed down.
3. If your are taking the capsule form of divalproex, swallow it whole; chewing the capsule may irritate your mouth.
4. The liquid form of valproic acid should not be mixed with carbonated beverages, such as soda pop. This may cause an unpleasant taste or mouth irritation.
5. To treat occasional pain, avoid the use of aspirin and related products , as it can affect the blood level of valproate; acetaminophen , or ibuprofen are safer alternatives.
6. Report any changes in mood or behavior to your physician.
7. Store your medication in a clean, dry area at room temperature. Keep all medication out of the reach of children.

If you have any questions regarding this medication, do not hesitate to contact your doctor, pharmacist, or nurse