Depakote Dosage Guide

What Is Depakote & How Is It Used?

Depakote, with the active ingredient divalproex sodium, is a medication that is FDA-approved for the treatment of mania associated with bipolar disorder, epilepsy, and migraine prevention.^{1, 2, 3, 4} Depakote works by calming the hyperactivity of the brain by increasing a chemical in the brain. It belongs to a group of medications called antiepileptic drugs, and it is sometimes referred to as a mood stabilizer.

Depakote delayed-release and extended-release tablets can be used for the indications above, but Depakote sprinkle capsules are mainly used as an anti-epileptic for those 10 years and older. For all three dosage forms, the treatment for epilepsy is indicated in ages 10 and older.

Depakote also has off-label uses, which are uses that have not been approved by the FDA but are prescribed because a provider believes the benefits may outweigh the risks. Examples of off-label uses for Depakote include diabetic neuropathy and nerve pain related to the herpes virus (such as with shingles).⁵ For the purpose of this article, mania associated with bipolar disorder will be the focus.

Depakote Forms & Strengths

Depakote comes in three different forms: delayed-release tablets, delayed-release sprinkle capsules, and extended-release tablets. It is also available as a generic drug called divalproex sodium. The form, strength, and dosage form that you receive depends on individual factors such as your age, conditions, and what other medications you are currently taking. Working with your doctor can help to determine which is right for you.

Depakote is available in the following forms and strengths:^{1, 2, 3, 4}

• 125 milligram (mg) delayed-release oral tablet
• 125 mg delayed-release oral sprinkle capsule
• 250 mg delayed-release oral tablet
• 500 mg delayed-release oral tablet

Depakote ER (extended-release) is available in the following forms and strengths:

• 250 mg extended-release oral tablet
• 500 mg extended-release oral tablet

Generic divalproex sodium is available in the following forms and strengths:

• 125 milligram (mg) delayed-release oral tablet
• 125 mg delayed-release oral sprinkle capsule
• 250 mg delayed-release oral tablet
• 500 mg delayed-release oral tablet

It is important to take medications as prescribed. Do not take more or less of the medication without discussing it with your provider. Tablets should be taken whole orally and should not be crushed or chewed. Sprinkle capsules may be taken whole or opened and sprinkled on soft food. If the capsules are opened, take the entire dose immediately as scheduled.

How to Take Depakote

Depakote should be taken exactly as your healthcare provider tells you. Do not take more or less of the medication without discussing it with them. Your healthcare provider may change your dose if needed. It is important to continue taking Depakote as prescribed. Do not stop taking them without speaking with your doctor first, as this can cause unintended side effects and worsening symptoms of your condition.

For delayed-release and extended-release tablets, swallow the tablets whole. Do not crush or chew these tablets, as it will affect how your body absorbs the medication. Depakote sprinkle capsules may be swallowed whole, or the capsules may be opened and the contents mixed into a small amount of soft food, such as applesauce or pudding, and swallowed immediately.²

Depakote Dosage for Adults With Manic Episodes

Bipolar disorder is a condition that requires long-term treatment to manage its symptoms. Depakote delayed-release and extended-release tablets are indicated to treat the symptoms of mania associated with bipolar disorder.

Here is Depakote dosage information for adults with manic episodes associated with bipolar disorder:^{1, 2, 3}

Depakote delayed-release tablets:

• Typical starting dosage: The recommended initial dose is 750 mg daily in divided doses.
• Dosage increases:  Dosage should be increased as rapidly as possible to get the patient to a therapeutic dose at the lowest dose possible.
• Maximum dosage:  The Depakote maximum recommended dose is based on weight, being 60 mg/kg/day. One kg is about 2.2 pounds (lbs).

Depakote extended-release tablets:

• Typical starting dosage: The recommended initial dose is 25 mg/kg/day given once daily.
• Dosage increases:  Dosage should be increased as rapidly as possible to get the patient to a therapeutic dose at the lowest dose possible. The dose that is right for you may depend on the desired effect it has on you, or it could be based on a desired amount of drug in your body, which is obtained through a blood test.
• Maximum dosage:  The Depakote max recommended dose is based on weight, being 60 mg/kg/day. One kg is about 2.2 pounds (lbs).

Depakote Dosage Restrictions

Dosages may differ between individuals as restrictions can prevent a person from receiving the standard Depakote dose. Certain medications you take may influence the dosage a person receives due to drug interactions. How you tolerate Depakote and its potential side effects, as well as your age, may influence your dosage. Elderly patients typically have lower starting doses due to how their body clears the medications.^{1, 3, 4} Your healthcare provider will consider if you need a different dosage due to personal factors.

What if I Miss a Dose of Depakote?

Depakote should be taken as prescribed. It is important to follow the instructions to avoid increasing the risk of Depakote side effects as well as ensuring your therapy works as intended. If you miss a dose, take the missed dose as soon as you remember. However, if it is almost time for your next dose, skip the missed dose and take your scheduled dose, following your normal Depakote dosing schedule afterward.

Do not double up on doses to make up for any missed ones. Some people stop taking Depakote because they may feel better, but it is important to know that this medication manages your symptoms and that it needs to be taken continuously to continue providing relief for your symptoms.

Others stop taking Depakote because they experience side effects, although these side effects usually go away as the body adjusts to the medication. It is important to continue taking Depakote and to talk to a doctor or pharmacist if you have questions about the medication. Do not stop taking this medication without discussing it with your physician.

*You should never suddenly stop taking your medication. Talk with your healthcare provider if you would like to stop taking your medication. They will help you create a plan to taper (slowly reduce) the medication.

Depakote Dosage FAQs

Depakote Dosing can differ for each individual depending on the diagnosis, the person’s age, and other factors. Below are some commonly asked questions about Depakote dosage.

How Long Does it Take for Depakote to Work?

With bipolar disorder, it may take several weeks to see a change in symptoms.⁵ It is important to keep taking Depakote even if you do not see results so that your body can have time to get used to the medication.

How Does Taking Depakote Long-term Affect the Dosage?

For cases like epilepsy and migraine, Depakote is typically taken long-term, but for mania associated with bipolar disorder, this medication usually is used for about 3 weeks. Long-term use for more than 3 weeks for bipolar mania has not been shown to be effective in controlled clinical trials, so doctors who elect to continue treatment for longer should consider long-term risk-benefits for individual patients.^{1, 2, 3}

Does Depakote Come in a Liquid Form to Be Given by IV?

Depakote and Depakote ER are provided as oral tablets or as a capsule taken by mouth. There are similar medications called valproate or valproic acid.⁵ Depacon (valproate sodium) comes as a solution that is given as an intravenous (IV) solution, but this medication is FDA-approved for seizures and not used in the treatment of mania associated with bipolar disorder or migraine prevention.

What Is a Loading Dose, & Does Depakote Need One?

A loading dose is an initial higher dose of a drug that is given at the beginning of a course of treatment. It is used to ensure that a therapeutic concentration of the drug is reached within the body quickly, thus improving the symptoms of one’s condition.

Typically, Depakote and Depakote ER are started low, and the dosage is increased with time, but in special cases, it is utilized. In cases like status epilepticus, a severe seizure event, a medication similar to Depakote, called valproic acid, is given through an IV to quickly alleviate symptoms.

Can You Overdose on Depakote?

There is a potential overdose on Depakote. An overdose occurs when too much of a medication is consumed, resulting in a toxic amount being present in the body. This can result in symptoms that may cause permanent or significant effects.

Not all overdoses are fatal or life-threatening, but they are serious and may require immediate medical attention. Overdoses in Depakote may look like a change in consciousness, irregular heartbeat, and confusion. It should be noted that the list below is not a comprehensive list.

Signs of an overdose on Depakote include:^{1, 2, 3, 4, 6}

• Extreme drowsiness
• Chest pain
• Dizziness
• Feeling faint or fainting
• Irregular pounding, beating or racing of the heart
• Coma
• Extreme thirst
• Confusion
• Muscle weakness

What Should You Do If You Take Too Much Depakote?

If you suspect you have taken too much Depakote, you may contact poison control for free on their website or their phone number (800-222-1222). Both options are available 24/7. A licensed professional can direct you on what steps you need to take and if you need further medical help. If you show symptoms of an overdose, call 911 or visit an emergency medical center as soon as possible to avoid serious or long-term effects.

Questions to Ask Your Healthcare Provider About Depakote Dosage

Talking with your doctor or psychiatrist is a necessary part of determining the most effective Depakote dosage for your symptoms. Bring any questions you have about Depakote and how it may affect you. If attending an in-person medical appointment is inaccessible to you, online psychiatry services may be an option to consider.

Questions to ask your care team about Depakote dosage include:

• How long will it take for me to adjust to taking Depakote?
• Am I at risk for more serious side effects if I am already taking other anxiety /depression medications?
• What is the best dosage to ensure fewer side effects?
• Is there anything I should tell my therapist about this new medication?
• How quickly will my Depakote dosage increase?
• Will I be taking Depakote long-term?
• Will my dosage be increased or decreased in the future?
• What foods can I use with Depakote sprinkle capsules?