In this drug factsheet:
What side effects are possible with this medication?
Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.
The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.
The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.
Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.
- abdominal or stomach cramps (mild)
- indigestion or heartburn
- loss of appetite
- nausea sedation
Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not seek medical attention.
Check with your doctor as soon as possible if any of the following side effects occur:
- abdominal or stomach cramps (severe)
- continuous, uncontrolled "back and forth" or rolling eye movements
- increase in seizures
- increasing tiredness and weakness with behaviour changes (extreme irritability, combativeness)nausea or vomiting (continuing)
- signs of bleeding (e.g., unusual nosebleeds, bruising, blood in urine, coughing blood, bleeding gums, cuts that don't stop bleeding)
- signs of depression (e.g., poor concentration, changes in weight, changes in sleep, decreased interest in activities, thoughts of suicide) or other mood changes
- signs of liver problems (e.g., nausea, vomiting, diarrhea, loss of appetite, weight loss, yellowing of the skin or whites of the eyes, dark urine, pale stools)
Seek immediate medical attention if any of the following occur:
- signs of pancreatitis (e.g., abdominal pain on the upper left side, back pain, nausea, fever, chills, rapid heartbeat, swollen abdomen)
- severe skin reactions on a large area of the body or on the lips (e.g., ulcers, blisters, pain, redness, skin peeling)
- signs of a serious allergic reaction (i.e., abdominal cramps, difficulty breathing, nausea and vomiting , or swelling of the face and throat)
Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.
Are there any other precautions or warnings for this medication?
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.
What other drugs could interact with this medication?
There may be an interaction between divalproex and any of the following:
- antipsychotic medications (e.g., haloperidol, perphenazine)
- ASA (acetylsalicylic acid)
- benzodiazepines (e.g., clonazepam, diazepam, lorazepam)
- HIV protease inhibitors (e.g., atazanavir, indinavir, ritonavir, saquinavir)
- macrolide antibiotics (e.g., clarithromycin, erythromycin)
- monoamine oxidase inhibitors (MAOIs; e.g., moclobemide, phenelzine, rasagiline, selegiline, tranylcypromine)
- selective serotonin reuptake inhibitors (SSRIs; e.g., citalopram, duloxetine, fluoxetine, paroxetine, sertraline)
- tricyclic antidepressants (e.g., amitriptyline, nortriptyline)
If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:
- stop taking one of the medications,
- change one of the medications to another,
- change how you are taking one or both of the medications, or
- leave everything as is.
An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.
Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.