Handouts · Medications
Valproate / Divalproex (Depakote)
A mood stabilizer for bipolar disorder (and seizures and migraine). Effective, but it carries important warnings, especially in pregnancy.
What It Is
Valproate steadies mood and is especially useful for manic or mixed episodes in bipolar disorder. It also treats seizures and prevents migraines.
How to Take It
Take with food to reduce stomach upset. Swallow extended-release tablets whole.
Take at the same times each day; do not stop suddenly.
Black Box Warnings
- Liver injury — rare but serious; highest risk in young children and early on.
- Pancreatitis — can occur at any time; severe belly pain, nausea, vomiting.
- Birth defects and lower IQ if taken in pregnancy — avoid if you could become pregnant unless there is no alternative and reliable contraception is used.
Common (Usually Mild) Side Effects
- Nausea, upset stomach.
- Hand tremor.
- Weight gain, drowsiness.
- Hair thinning (a zinc/selenium supplement may help).
Serious — Seek Care Now
- Liver problems: yellow skin/eyes, dark urine, unusual tiredness, loss of appetite.
- Pancreatitis: severe upper-belly pain with vomiting.
- Easy bruising or bleeding (low platelets).
- Confusion or extreme sleepiness (high ammonia).
Alcohol & Interactions
Avoid alcohol — it adds stress to the liver and to sedation.
Valproate raises lamotrigine levels and interacts with several other medicines — keep your list current.
Required Monitoring
• Liver tests (LFTs) — at baseline and periodically
• Blood count and platelets (CBC)
• Valproate blood level to guide dosing
• Ammonia if you become confused or very drowsy
Tell us right away if you might be pregnant.