Depakote is a prescription medication used in the treatment of bipolar disorder, epilepsy, and migraine prevention. Common side effects associated with this medication can be broad, affecting the digestive tract, causing headaches, dizziness, belly and back pain, tremors, and other side effects. Severe side effects associated with Depakote include pancreatitis, liver damage, allergic reactions, bleeding problems, and a potential increase in suicidal behavior or ideation. Some side effects can remain long-term.
What Is Depakote & How Is it Used?
Depakote contains the active ingredient divalproex sodium and is a medication FDA-approved for the treatment of manic episodes associated with bipolar disorder, epilepsy, and migraine prevention.1,2 FDA approval means that the medication has gone through extensive review, ensuring that there is data to support that it is safe and effective for its intended use.
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This medication may also be used off-label for diabetic peripheral neuropathy, postherpetic neuralgia, status epilepticus, and other conditions related to traumatic brain injuries.3 When a medication is used off-label, a doctor is prescribing it for a purpose not indicated by the FDA using their professional judgment, which means they think it will bring more benefit than harm.
Depakote is a delayed-release medication that may be given in divided doses during the day. It is also available as Depakote ER, an extended-release version that is given once a day. Both Depakote and Depakote ER share the same FDA-approved uses, but Depakote ER is used to treat acute manic or mixed episodes associated with bipolar disorder with or without psychotic features, Depakote is used for manic episodes associated with bipolar disorder, and both are used to prevent migraine headaches.4
Depakote works by increasing the amount of a chemical called GABA in the brain, which is thought to balance the chemicals in the body, but the exact mechanism of how it works is unknown. It is formulated as a delayed-release tablet, a delayed-release sprinkle capsule, and an extended-release tablet which is sold as both brand and generic versions.3
Serious Side Effects of Depakote
Serious side effects associated with Depakote involve reactions that may be potentially life-threatening. If you develop serious side effects while taking Depakote, talk with your healthcare provider, seek immediate medical care, or call 911. Some of the serious side effects a person could experience while on Depakote involve damage to the liver or inflammation of the pancreas, causing a severe allergic reaction, or it can cause bleeding problems or suicidal ideation. If you experience signs of bleeding (internally or externally), have unexplained pain or feelings of unwellness, or changes in your behavior or thoughts, then consult a doctor.
Serious side effects of Depakote include:1,2
Severe Allergic Reaction
Those who are allergic to divalproex sodium, valproic acid, sodium valproate, or any of the ingredients in Depakote may experience a severe allergic reaction. This may include anaphylaxis, which is a severe allergic reaction that requires medical attention. Symptoms of severe allergic reactions may include swelling of the lips, tongue, or throat, trouble breathing, skin rashes or hives, and dizziness or fainting.1,2
It’s also possible for Depakote to cause serious skin reactions, such as drug reactions with eosinophilia and systemic symptoms (DRESS). If you experience blistering or discoloration of your skin, it is important to seek emergency treatment or call 911 right away.
Pancreatitis
Cases of life-threatening pancreatitis have been reported in both children and adults who took Depakote. Cases have been reported when patients have just started Depakote and when they have been on it for several years. Patients and guardians should be aware of symptoms such as abdominal pain, nausea, vomiting, and anorexia, which can be symptoms of pancreatitis. You should seek immediate care if you have these symptoms.1,2
Bleeding Problems
Depakote may cause low platelet levels. Platelets help to form clots in the blood when an injury occurs. When a person has low platelet levels, they are at a higher risk of bleeding. Signs of low platelet levels include bleeding that lasts longer than normal, unusual bruising, dark and tarry stools, and vomit that looks like coffee grounds. Seek immediate medical care if you experience signs or symptoms of bleeding.1,2
Liver Damage
Liver failure resulting in fatalities has occurred in patients receiving Depakote. These incidents usually occur during the first six months of treatment. Non-specific symptoms may precede serious or fatal liver problems. Such symptoms of liver problems may include tiredness, vomiting, weakness, a general feeling of being unwell, or weight loss.1,2
Suicidal Behavior & Ideation
Depakote may increase the risk of suicidal thoughts or behavior in patients. Those who take Depakote should be monitored for new or worsening depression, suicidal thoughts or behavior, and any unusual changes in their mood or behavior. The risk of suicidal ideation or behavior occurring was similar between those being treated for epilepsy and any psychiatric reason.1,2
Increased Levels of Ammonia
Depakote can cause increased levels of ammonia in your body, which can cause dangerous side effects, including brain damage and hypothermia. Talk with your healthcare provider to learn about signs to watch for and your risk for serious side effects, such as increased levels of ammonia.
*All medications, including Depakote, can cause side effects that can be mild or serious. This is not a comprehensive list of all possible side effects. You should talk with your doctor about any questions you have and to understand the potential side effects and benefits of any medication.
Common Side Effects of Depakote
Depakote, like all medications, may cause unintended side effects. Depakote has more side effects that are considered commonly occurring, so the following list is not a complete list. Depakote can cause general side effects like headaches, dizziness, drowsiness, and digestive side effects, but it can also cause unique adverse reactions like hair loss and tremors. Some side effects may require medical attention.
Common side effects of Depakote include:*1,2
- Abdominal and back pain
- Hair loss
- Blurred vision
- Dizziness
- Physical weakness or lack of energy
- Rapid and dramatic shifting between different emotional states
- Drowsiness
- Tremor
- Digestive side effects (nausea, vomiting, diarrhea, indigestions, etc.)
- Headache
*All medications, including Depakote, can cause side effects that can be mild or serious. This is not a comprehensive list of all possible side effects. You should talk with your doctor about any questions you have and to understand the potential side effects and benefits of any medication.
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Can Depakote Cause Long-term Side Effects?
It is possible for Depakote to cause long-term side effects. There are warnings associated with the medication for the risk of liver damage, including liver failure and pancreatitis (swelling of the pancreas), among others. These serious side effects can occur in people who have just started taking Depakote or those who have been on Depakote for years.
Liver damage usually occurs within the first six months of treatment, while pancreatitis can happen shortly after Depakote has been started in patients as well as after several years of usage. These can be long-term complications that are potentially life-threatening. If you show symptoms of pancreatitis or liver damage, immediately seek medical care.
Frequently Asked Questions
Can Depakote Cause Sexual Side Effects in Men & Women?
It is possible that Depakote can cause sexual dysfunction in men and women. It’s important to note that sexual side effects were not reported in clinical trials. Antiseizure drugs are known to have side effects involving the endocrine system, which is the system that deals with sexual functions. Depakote may affect hormone levels and cause issues such as menstrual disturbances, sexual problems, and reduced fertility.5
Does the Risk of Side Effects Increase With Higher Doses of Depakote?
There is a potential increase in risk when the dosage of Depakote is increased. The clinical research studies did not directly compare the different doses for any of the formulations and if that increase in dosage correlated to an increased risk of side effects. If you experience a side effect, consult with your doctor or seek immediate care if it is serious.2,6,7
Can Depakote Cause Weight Gain?
Depakote may cause weight gain. It is a common side effect associated with the medication, along with weight loss.1,2 Weight change is usually due to appetite changes in patients. Drug-induced weight gain from Depakote can lead to patients not being adherent to their therapy. If you experience this side effect and it is a problem for you, then contact your doctor to discuss your options. Keep in mind that weight loss can be a sign of liver damage which requires immediate medical care.
Can I Take Depakote While Pregnant?
Depakote may cause fetal harm when taken by those who are pregnant. It may cause neural tube defects and other structural abnormalities. Those who are pregnant or may become pregnant should avoid taking this medication unless other medications have failed to manage their condition and no other alternatives exist. Discuss with your doctor if there may be concern over this side effect.1,2
Do Older People Have a Higher Risk of Side Effects on Depakote?
Yes, older patients can be at greater risk of side effects while on Depakote. In clinical trials, those 65 years and older were more likely to report tremors, drowsiness, pain, accidental injury, and infection while on Depakote. It isn’t clear whether these events mean that this group is at additional risk or if they were a result of pre-existing medical conditions and other medications taken at the same time as Depakote. Consult your doctor if you experience these problems, as they may reduce your dosage or discontinue the medication altogether.1,2
How to Manage Side Effects of Depakote
Depakote has several potential side effects. Some of them are serious, while others may be more mild, typically manageable for those on the medication. Sometimes, side effects may be managed, whether that be through at-home methods to make symptoms more manageable or by talking with your doctor. Always consult a healthcare provider if you are experiencing problems that worsen or interfere with your daily life.
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Tremors
Tremors are a common side effect associated with Depakote, where the populations most affected are women and patients over 65 years of age. This side effect may be dose-related.1,2 If you experience tremors while on Depakote, contact your healthcare provider. Potential treatments for tremors caused by Depakote are medication adjustments and the addition of other medications to manage the tremors.
Digestive Side Effects
There are several side effects that involve the gastrointestinal tract, including constipation, diarrhea, nausea, upset stomach, vomiting, and stomach pain. You should talk to your doctor if you are experiencing these side effects as they can determine if they need to adjust your treatment, suggest treatment options for your symptoms, or if your symptoms are a sign of bigger problems that need to be addressed.
Drowsiness and Dizziness
Drowsiness and dizziness may be tolerable or a temporary event as the body gets used to the medication, but tolerance depends on other conditions a person may have. These side effects can be especially dangerous for those who are at a higher risk of falls and injury. To reduce your risk, make sure to get a full night’s rest and avoid taking any stimulants like medications or caffeine near bedtime. If you continue to deal with these side effects, contact your doctor.
Headache
Headaches are a side effect associated with Depakote, being one of the few side effects that is considered common for the medication. This side effect reportedly occurred in more than 5% of patients on Depakote.2 If you experience headaches, you may be able to take over-the-counter pain relievers to manage the symptoms. If you continue to experience headaches or they worsen, contact a doctor for further help.
Hair Loss
Hair loss, also known as alopecia, is a common side effect that may occur to those on Depakote. The risk of hair loss may be greater at higher dosages. This side effect was reported by those who took Depakote to treat seizures or to help prevent migraine headaches. Hair loss during treatment usually grew back when the patient stopped taking Depakote. If you experience hair loss while on Depakote, contact your doctor. They may recommend another treatment to help with the side effects or suggest a change in therapy altogether.
Questions to Ask Your Healthcare Provider About Depakote Side Effects
To prepare yourself for taking Depakote, ask your doctor questions to inform yourself on what to expect from the medication. It is wise to have an open and honest conversation to ensure you have a realistic expectation of what the medication should do for you and the risks associated with it.
Questions to ask your care team about Depakote side effects:
- 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 medications?
- What is the best Depakote dosage to ensure fewer side effects?
- What side effects require immediate medical care?
- Do any of my medications interact with Depakote and increase my chance of a side effect?
- Are there any side effects I should watch out for in relation to my pre-existing conditions?
- Are there any lifestyle changes I should consider while on Depakote?
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