BOX WARNING
HEPATOTOXICITY
HEPATIC FAILURE RESULTING IN FATALITIES HAS OCCURRED IN PATIENTS RECEIVING VALPROIC ACID AND ITS DERIVATIVES. EXPERIENCE HAS INDICATED THAT CHILDREN UNDER THE AGE OF TWO YEARS ARE AT A CONSIDERABLY INCREASED RISK OF DEVELOPING FATAL HEPATOTOXICITY, ESPECIALLY THOSE ON MULTIPLE ANTICONVULSANTS, THOSE WITH CONGENITAL METABOLIC DISORDERS, THOSE WITH SEVERE SEIZURE DISORDERS ACCOMPANIED BY MENTAL RETARDATION, AND THOSE WITH ORGANIC BRAIN DISEASE. WHEN DEPACON IS USED IN THIS PATIENT GROUP, IT SHOULD BE USED WITH EXTREME CAUTION AND AS A SOLE AGENT. THE BENEFITS OF THERAPY SHOULD BE WEIGHED AGAINST THE RISKS. ABOVE THIS AGE GROUP, EXPERIENCE IN EPILEPSY HAS INDICATED THAT THE INCIDENCE OF FATAL HEPATOTOXICITY DECREASES CONSIDERABLY IN PROGRESSIVELY OLDER PATIENT GROUPS.
THESE INCIDENTS USUALLY HAVE OCCURRED DURING THE FIRST SIX MONTHS OF TREATMENT. SERIOUS OR FATAL HEPATOTOXICITY MAY BE PRECEDED BY NON-SPECIFIC SYMPTOMS SUCH AS MALAISE, WEAKNESS, LETHARGY, FACIAL EDEMA, ANOREXIA, AND VOMITING. IN PATIENTS WITH EPILEPSY, A LOSS OF SEIZURE CONTROL MAY ALSO OCCUR. PATIENTS SHOULD BE MONITORED CLOSELY FOR APPEARANCE OF THESE SYMPTOMS. LIVER FUNCTION TESTS SHOULD BE PERFORMED PRIOR TO THERAPY AND AT FREQUENT INTERVALS THEREAFTER, ESPECIALLY DURING THE FIRST SIX MONTHS.
TERATOGENICITY
VALPROATE CAN PRODUCE TERATOGENIC EFFECTS SUCH AS NEURAL TUBE DEFECTS (E.G., SPINA BIFIDA). ACCORDINGLY, THE USE OF VALPROATE PRODUCTS IN WOMEN OF CHILDBEARING POTENTIAL REQUIRES THAT THE BENEFITS OF ITS USE BE WEIGHED AGAINST THE RISK OF INJURY TO THE FETUS. THIS IS ESPECIALLY IMPORTANT WHEN THE TREATMENT OF A SPONTANEOUSLY REVERSIBLE CONDITION NOT ORDINARILY ASSOCIATED WITH PERMANENT INJURY OR RISK OF DEATH (E.G., MIGRAINE) IS CONTEMPLATED. SEE WARNINGS, INFORMATION FOR PATIENTS.
PANCREATITIS
CASES OF LIFE-THREATENING PANCREATITIS HAVE BEEN REPORTED IN BOTH CHILDREN AND ADULTS RECEIVING VALPROATE. SOME OF THE CASES HAVE BEEN DESCRIBED AS HEMORRHAGIC WITH A RAPID PROGRESSION FROM INITIAL SYMPTOMS TO DEATH. CASES HAVE BEEN REPORTED SHORTLY AFTER INITIAL USE AS WELL AS AFTER SEVERAL YEARS OF USE. PATIENTS AND GUARDIANS SHOULD BE WARNED THAT ABDOMINAL PAIN, NAUSEA, VOMITING, AND/OR ANOREXIA CAN BE SYMPTOMS OF PANCREATITIS THAT REQUIRE PROMPT MEDICAL EVALUATION. IF PANCREATITIS IS DIAGNOSED, VALPROATE SHOULD ORDINARILY BE DISCONTINUED. ALTERNATIVE TREATMENT FOR THE UNDERLYING MEDICAL CONDITION SHOULD BE INITIATED AS CLINICALLY INDICATED. (See WARNINGS and PRECAUTIONS.)
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DEPACON SUMMARY
Valproate sodium is the sodium salt of valproic acid designated as sodium 2-propylpentanoate.
DEPACON is indicated as an intravenous alternative in patients for whom oral administration of valproate products is temporarily not feasible in the following conditions:
DEPACON is indicated as monotherapy and adjunctive therapy in the treatment of patients with complex partial seizures that occur either in isolation or in association with other types of seizures. DEPACON is also indicated for use as sole and adjunctive therapy in the treatment of patients with simple and complex absence seizures, and adjunctively in patients with multiple seizure types that include absence seizures.
Simple absence is defined as very brief clouding of the sensorium or loss of consciousness accompanied by certain generalized epileptic discharges without other detectable clinical signs. Complex absence is the term used when other signs are also present.
SEE WARNINGS FOR STATEMENT REGARDING FATAL HEPATIC DYSFUNCTION.
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NEWS HIGHLIGHTS
Published Studies Related to Depacon (Valproate)
Risperidone versus risperidone plus sodium valproate for treatment of bipolar
disorders: a randomized, double-blind clinical-trial. [2014] CONCLUSIONS: Risperidone can be effective and well tolerated in both acute manic
Assessment of cognitive impairments and seizure characteristics in
electroconvulsive therapy with and without sodium valproate in manic patients. [2013] characteristics in patients with and without concurrent sodium valproate therapy... CONCLUSIONS: Continuing the administration of sodium valproate neither adversely
Valproic acid, valproate and divalproex in the maintenance treatment of bipolar
disorder. [2013] CONCLUSIONS: Limited evidence supports the efficacy of valproate in the
Add-on memantine to valproate treatment increased HDL-C in bipolar II disorder. [2013] Memantine is a noncompetitive NMDA receptor antagonist...
Assessment of cognitive impairments and seizure characteristics in
electroconvulsive therapy with and without sodium valproate in manic patients. [2013] characteristics in patients with and without concurrent sodium valproate therapy... CONCLUSIONS: Continuing the administration of sodium valproate neither adversely
Clinical Trials Related to Depacon (Valproate)
A Study in Stable Epilepsy Patients Comparing Brand and Generic Divalproex Sodium Extended Release Tablets [Recruiting]
Valproic Acid for the Prevention of Post-Amputation Pain [Recruiting]
The objectives of this study are, to test the effectiveness of Valproic Acid (VPA) in the
prevention of chronic neuropathic and post-amputation pain, as well as to further define the
underlying inflammatory and epigenetic mechanisms that lead to the development of such
chronic pain.
HYPOTHESES AND QUESTIONS
Hypothesis 1: The use of oral valproic acid in combination with regional anesthesia in
surgical limb-injury patients will decrease the incidence of chronic nerve injury and
post-amputation pain.
Goal 1: In a blinded, randomized placebo-controlled, multi-center clinical trial,
investigators will determine if oral VPA added to regional anesthesia and standard
perioperative management will reduce the incidence of nerve injury and post-amputation pain
when compared with regional anesthesia alone.
Hypothesis 2: The transition from acute to chronic pain is mediated via epigenetic
mechanisms (differential DNA methylation) in genes involved in nociception.
Goal 2: Investigators will analyze the DNA methylation patterns of patients with different
types of neuropathic and post-amputation pain and determine if they are altered by VPA.
Bevacizumab, Temsirolimus, Valproic Acid, Cetuximab [Recruiting]
The goal of this clinical research study is to find the highest tolerable dose of Avastin
(bevacizumab) and Torisel (temsirolimus) that can be given in combination with either
valproic acid or cetuximab to patients with advanced cancer that is refractory. The safety
of this drug combination will also be studied.
Bevacizumab is designed to block the growth of blood vessels, which may help to slow or
block the growth of cancer.
Temsirolimus is designed to block the growth of cancer cells, which may cause cancer cells
to die.
Valproic acid is an anti-seizure drug that may be able to activate tumor-fighting genes,
causing cancer cells to die.
Cetuximab is designed to block a certain protein, called EGFR, that is thought to cause
cancer cells to grow. This may cause cancer cells to die.
Valproate in Late Life Schizophrenia [Completed]
The purpose of this research study is to analyze the effectiveness and tolerability of a
medication, valproate ( Depakote and Depakote ER), in individuals age 50 years and older who
have schizophrenia.
Depakote Extended Release (ER) Versus Seroquel for Agitated Behaviors in Nursing Home Care Unit Patients With Dementia [Completed]
The primary objective of the study is to assess the relative efficacy of Depakote ER and
Seroquel for agitated behaviors among veterans with a dementia diagnosis residing in a
Department of Veterans Affairs (VA) nursing home care unit (NHCU). The secondary objective
of the study is to assess the relative tolerability of Depakote ER and Seroquel in this
population. The primary hypothesis is that agitated dementia patients will demonstrate a
significantly greater reduction in Cohen-Mansfield Agitation Inventory (CMAI) scores while
treated with Depakote ER compared to treatment with Seroquel.
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Page last updated: 2015-08-10
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