Depakote ER Warnings and Precautions

There is a lot of important information to be aware of before starting Depakote ER. Warnings and precautions with this medicine specifically include watching for signs of pancreatitis, knowing which drugs may interact with Depakote ER, and notifying your doctor if you have unusual bruises or bleeding. You should not take Depakote ER if you are allergic to any components of the drug, have a urea cycle disorder, or have liver disease.

Depakote ER: What Should I Tell My Healthcare Provider?

You should talk with your healthcare provider prior to taking Depakote ER® (divalproex ER) if you have:
 
  • Liver disease, such as liver failure or cirrhosis
  • A urea cycle disorder
  • Mental retardation
  • A blood disorder
  • Any allergies, including allergies to food, dyes, or preservatives.
     
Also let your healthcare provider know if you are:
 
  • Pregnant or thinking of becoming pregnant
  • Breastfeeding.
     
You should also make sure to tell your healthcare provider about all other medicines you are taking, including prescription and non-prescription medicines, vitamins, and herbal supplements.
 

Specific Depakote ER Warnings and Precautions

Some warnings and precautions to be aware of prior to taking Depakote ER include:
 
  • There have been cases of liver failure caused by Depakote ER. Children less than two years of age are at particularly high risk, especially children with mental retardation, brain damage or disease, or certain other health problems. Depakote ER is not approved for children less than 10 years of age, and should rarely be used in young children, due to the risk of liver damage.
     
  • You should not take Depakote ER if you have liver disease. Also, you should not take Depakote ER if you have a urea cycle disorder (a problem with the enzymes that clear ammonia from the body, leading to high ammonia levels in the blood), as the drug may worsen this condition. You should be evaluated for a urea cycle disorder if you have a history of:

 

    • A brain disease or a problem associated with pregnancy
    • Unexplained brain disease or problems
    • Unexplained mental retardation
    • High ammonia levels in your blood
    • Vomiting and lethargy that come and go regularly.

 

  • Depakote ER can cause pancreatitis (inflammation of the pancreas), which may be very dangerous. Let your healthcare provider know immediately if you have any signs of pancreatitis, including:

 

    • Severe abdominal pain (or stomach pain)
    • Nausea and vomiting
    • Loss of appetite.

 

  • Elderly people may be more sensitive to Depakote ER side effects, such as drowsiness. If you are elderly and take Depakote ER, your healthcare provider should monitor you more closely.
     
  • Depakote ER can cause low platelets in the blood (thrombocytopenia). Tell your healthcare provider if you have any unusual bruises or bleeding.
     
  • As with all seizure medications, Depakote ER should not be stopped suddenly (see Depakote Withdrawal).

 

  • Depakote ER can cause hypothermia (a body temperature below 95 degrees F), which can be dangerous. Let your healthcare provider know if you develop hypothermia.

 

  • Let your healthcare provider know right away if you have a rash along with a fever or any other symptoms, as this may be a sign of a dangerous allergic reaction.
     
  • Depakote ER can potentially interact with certain other medications (see Depakote ER Drug Interactions).
     
  • Depakote ER is considered a pregnancy Category D medication when used for the treatment of epilepsy or bipolar disorder. This means that it is probably not safe for pregnant women in these situations. Depakote ER is considered a pregnancy Category X medication when used for the prevention of migraine headaches. This means that the risks of taking this medication during pregnancy clearly outweigh the benefits in this situation.  
 
Talk with your healthcare provider about the risks and benefits of taking the drug during pregnancy (see Depakote and Pregnancy). Depakote ER may increase the risk of birth defects and "cognitive impairment" problems (such as lower intelligence).
 
  • Depakote ER passes through breast milk. Therefore, if you are breastfeeding or plan to start breastfeeding, discuss this with your healthcare provider prior to taking the drug (see Depakote and Breastfeeding).

 

  • Early evidence suggests that seizure medications, including Depakote ER, may increase the risk of suicidal thoughts or behaviors (see Seizure Medications and Suicide for more information).
     
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