DIVALPROEX
(Epival)Standard Prescription
divalproex__mg PO Q__H (__mg/kg/24hr)
Dosages
For status epilepticus, see valproic acid
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)
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
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 BIDIncrease 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
Mechanism of Action
Anticonvulsant
Forms Supplied
Enteric coated tablet: 125 mg, 250 mg, 500 mg
Sprinkle caps: 125 mg (available through Health Canada Special Access Program only)
Sprinkle caps: 125 mg (available through Health Canada Special Access Program only)
Comments
Hazardous drug. Refer to Hazardous Drug Handling Policy
Click here for Therapeutic Drug Monitoring (see white pages in print copies).
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.
References
32, 44, 337
Last Edited
2022-06-18 20:54:39