Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.
Blood clotting: This medication may make it more difficult for the blood to clot. If you take anticoagulant medications (blood thinning) medications, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. If you notice any signs of bleeding, such as frequent nosebleeds, unexplained bruising, or black and tarry stools, notify your doctor as soon as possible. Your doctor will order routine blood tests to make sure potential problems are caught early.
Drowsiness/reduced alertness: Divalproex may cause drowsiness, especially when combined with alcohol or another sedating medication. Avoid driving or other potentially dangerous activities until you determine how this medication affects you.
Kidney disease: Kidney disease or reduced kidney function may cause divalproex to build up in the body, causing side effects. If you have reduced kidney function or kidney disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Liver function: Liver failure has occurred infrequently for people taking divalproex. In most cases, this has happened during the first 6 months of treatment. The risk is highest for children under the age of 2 years, especially those who take more than one antiseizure medication, or those who have certain medical conditions (e.g., metabolic disorders and brain disease). Children aged 3 to 10 years are also at a higher risk if they take more than one antiseizure medication. Liver function tests should take place before starting treatment with divalproex. Your doctor may also perform liver function tests regularly to monitor the function of your liver. Serious liver problems may be preceded by symptoms such as loss of seizure control, malaise, weakness, lethargy, loss of appetite, and vomiting. People who take valproic acid should tell their doctor at once if they experience these symptoms. Increases in the levels of ammonia in the blood, with or without lethargy or coma, have been reported and may be present despite normal liver function tests.
Pancreatitis: People taking divalproex have experienced life-threatening pancreatitis (inflammation of the pancreas). These cases have occurred shortly after starting the medication and after several years of taking the medication. If you experience signs of pancreatitis such as abdominal pain on the upper left side, back pain, loss of appetite, nausea, fever, chills, rapid heartbeat, or swollen abdomen contact your doctor immediately.
Suicidal thoughts: There is a small risk that this medication may result in thoughts of suicide. If you experience these symptoms or any other behaviour change while taking this medication, contact your doctor immediately. Family members or caregivers of people who are taking this medication should contact the person's doctor immediately if they notice unusual behaviour changes.
Stopping this medication: People who need this medication to prevent major seizures should not stop taking it suddenly as this can increase the risk of getting seizures. Do not stop taking this medication without consulting with your doctor first.
Pregnancy: There is an increased risk of birth defects for a child whose mother takes divalproex during pregnancy. Although rare, divalproex may cause a defect of the spine called spina bifida or slowed or reduced mental development. This medication should not be used during pregnancy unless the benefits outweigh the risks.
Before becoming pregnant, women who are taking divalproex should speak to their doctor. If you become pregnant while taking this medication, contact your doctor immediately.
Breast-feeding: This medication passes into breast milk. If you are a breast-feeding mother and are taking divalproex, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding. As a general rule, women who are taking divalproex should not breast-feed.
Children: If divalproex is taken by children 2 years old or younger, it should not be used in combination with other antiseizure medications and the doctor should monitor the child regularly. Divalproex is not recommended for treatment of mania in children under 18 years of age.
Seniors: People over the age of 65 may be more at risk of developing side effects from this medication and may require lower dosages.