Depakote Formulations

Recognizing the difference between Depakote formulations can be challenging. We often get asked which one to use. This info should help. We will discuss Tuesday AM.

Learning objectives:

1. Recommend the best form of depakote for any given situation
2. Choose a cost-effective depakote option

So, what’s the deal with all these Depakote formulations???

What is the difference between “Valproate” and “Divalproex”?

• Valproate/valproic acid VS divalproex sodium
  • Valproate/valproic acid = active molecule
    • Valproic acid = acid form
      • Harsher on the stomach
    • Sodium valproate = salt form
    • This is immediate-release form
  • Divalproex sodium
    • Compound made of sodium valproate and valproic acid combined in 1:1 ratio
    • More GI-friendly
  • All forms become valproate in the bloodstream, once absorbed

What is the difference between divalproex DR and ER?

• Divalproex
  • Formulated as delayed-release and extended-release
  • Less nausea and GI upset
  • Smoother absorption curves
• Divalproex DR (delayed-release)
  • AKA EC (enteric coated)
  • Has an enteric coating
    • Dissolves in intestine (not stomach)
  • Dosed 2-3x/day
  • Peaks faster than ER
  • Often used inpatient when you want faster effect
• Divalproex ER (extended-release)
  • Dosed 1x/day
  • Releases slowly over 24 hours
  • Lower peak levels
  • Less sedation and GI side effects
  • 10-20% lower bioavailability than DR
    • If someone on 1000mg DR, they  need 1250mg ER
• Cost
  • There are generics for both divalproex DR and ER, so cost should be comparable for both
  • Brand name depakote ER is more expensive

What form are the sprinkles, syrup, and IV formulation?

• Divalproex sprinkles
  • Still divalproex
  • Capsule filled with enteric-coated beads
  • DR not ER
  • Usually BID dosing
• Valproate syrup (valproic acid solution)
  • Immediate-release liquid
  • Absorbed quickly
  • More GI irritation
  • Good for NG tube, severe dysphagia, need for rapid titration
• IV valproate (valproate sodium injection)
  • Brand called depacon
  • 1:1 conversion from PO dose
  • Divided q6h
  • Bioavailability 100%
  • Same dose as divalproex DR (DR has a pretty high bioavailability too)