Valproate
Brand: Depakote, Depakote ER (Depakene discontinued)
Boxed warning
Hepatotoxicity (fatal liver failure, highest under age 2), fetal risk (neural tube defects and reduced IQ), and pancreatitis.
- Caution
- Contraindicated in pregnancy for migraine; thrombocytopenia and weight gain.
- Pregnancy
- Avoid in pregnancy: neural tube defects and lower IQ in the child (boxed); contraindicated for migraine prevention.
Common side effects
- Nausea
- Weight gain
- Tremor
- Hair thinning
Key interactions
- Raises lamotrigine levels: rash risk rises
- Additive sedation with CNS depressants
- Raises warfarin's effect
Counseling points
- Liver function and drug levels are monitored
- Report yellowing of the skin or eyes, or severe abdominal pain
- Take with food to reduce stomach upset
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