DRUG SUPPLIED DOSE COMMENTS
DIVALPROEX (Paeds)
(Epival)

Mechanism of action:

Anticonvulsant



Ref: 32, 44, 337



Last update: 2022-06-18		 Enteric coated tablet: 125 mg, 250 mg, 500 mg

Sprinkle caps: 125 mg (available through Health Canada Special Access Program only)		 For status epilepticus, see valproic acid

Seizures:
Children:
Initial:  2.5-5 mg/kg/dose PO BID
Increase by:  2.5-5 mg/kg/dose PO BID every 5-7 days
Maintenance: 10-15 mg/kg/dose PO BID
Maximum: 20-30 mg/kg/dose PO BID or 1500 mg/dose PO BID, whichever is less (Use higher maximum of 60 mg/kg/24 hr only in rare cases, based on individual clinical response and levels)

Adolescents:
Initial: 125-250 mg/dose PO BID
Increase by: 125-250 mg/dose PO BID every 5-7 days
Maintenance: 500-1000 mg/dose PO  BID
Maximum: 1500 mg/dose PO BID

Migraine Prophylaxis:
Adolescents >16 years:
Initial: 250 mg/dose PO BID.  Adjust based on clinical response
Maximum: 500 mg/dose PO BID

 Hazardous drug.  Refer to Hazardous Drug Handling Policy

Avoid in mitochondrial/urea cycle disorders.

Caution in < 2 yrs old: increased risk of hepatic failure, particularly in those with undiagnosed inborn errors of metabolism.

Teratogenic: Risk of significant congenital malformations if taken during pregnancy.

Divalproex dissociates into valproic acid in the GI tract. Dose is equivalent to valproic acid.

Effective as a mood stabilizer in bipolar disorder and for migraine prophylaxis.

Do not chew or crush enteric coated tablets.

Dose related adverse effects: GI upset, drowsiness,tremor, weight gain, thrombocytopenia, hair loss.

Idiosyncratic adverse effects: hepatoxitcity, pancreatitis, hyperammonemia.

Monitor CBC and liver function at baseline and periodically if clinically indicated.

Associated with Polycystic Ovary Syndrome.

Substrate of CYP 2C9, 2C19; inhibits CYP 2C9, 2C19; highly protein bound. Check for drug interactions.

Post load (valproic acid) level taken 3 hours after PO load - Target Level: 350-700 μmol/L.

Click here for Therapeutic Drug Monitoring (see white pages in print copies).



Standard Prescription:

divalproex__mg PO Q__H (__mg/kg/24hr)