Divalproex sodium brands and prices in Pakistan

About Divalproex sodium (valproate semisodium)

Divalproex sodium is a form of valproate, an anti-epileptic and mood-stabilising medicine. In the UK it is called valproate semisodium or semisodium valproate. It is made of sodium valproate and valproic acid joined together, and the body uses it as valproic acid. It calms electrical activity in the brain. It is a prescription medicine that must be started by a specialist. Valproate can seriously harm an unborn baby, so there are strict rules about its use in anyone who could become pregnant.

Who should not take it, or should take care

• PREGNANCY - SERIOUS WARNING: valproate taken in pregnancy can cause birth defects in about 1 in 9 babies (11 in 100). These include spina bifida, cleft lip and palate, and problems with the limbs, heart, kidneys, genitals, eyes or hearing (MHRA).
• About 3 or 4 in every 10 children exposed before birth may have problems with early development, such as being late to walk and talk, lower intelligence, poor speech and language, and memory problems. These can be serious and lifelong. There is also a higher chance of autism and lower birth weight, and some evidence of a higher chance of ADHD (MHRA).
• In the UK, valproate must not be prescribed to any woman or girl who could become pregnant unless the Pregnancy Prevention Programme is followed. This means using effective contraception (even if not sexually active), having a treatment review every year, and signing a risk form with the specialist (MHRA, NHS).
• In the UK, people under 55 should only start valproate if two specialists agree that other treatments are not suitable and the benefits outweigh the risks (MHRA).
• If you think you might be pregnant, or you are planning a pregnancy, contact your doctor urgently. Do not stop taking it on your own: stopping suddenly can bring on severe seizures and can be dangerous for both mother and baby (NHS, FDA, MHRA).
• The US FDA says valproate must not be used to prevent migraine in pregnancy, because it lowers IQ scores in exposed children. For epilepsy or bipolar disorder in pregnancy, it should be used only when other medicines do not work or are not suitable (FDA).
• Men: valproate may reduce fertility, which may improve after stopping. Because of a possible small risk of learning or behaviour problems in children, men taking it and their partners are advised to use effective contraception during treatment and for a time after stopping. Men planning a family should talk to their doctor, but not stop the medicine on their own (MHRA, NHS).
• Do not take it if you have active liver disease or a personal or family history of serious liver problems, a urea cycle disorder, porphyria, a mitochondrial disease caused by POLG gene changes (such as Alpers-Huttenlocher syndrome), or primary carnitine deficiency.
• Tell your doctor if you have lupus (SLE), HIV or CMV infection, diabetes (it can give false urine ketone results) or any past confusion or coordination problems, and before any operation, including dental work.
• Breastfeeding: small amounts pass into breast milk. The NHS says it may be used if the baby is healthy and no other treatment is suitable. Contact a doctor if the baby feeds poorly, is unusually sleepy, bruises easily, vomits or looks yellow.

Medicines and drinks that can interact

• Carbapenem antibiotics such as meropenem and imipenem: these sharply lower valproate levels and should not be used together
• Lamotrigine: valproate increases lamotrigine levels and the risk of a serious skin rash
• Contraceptives and other medicines containing oestrogen, which may lower valproate levels
• Topiramate or acetazolamide, which can raise ammonia levels and affect the brain
• Other epilepsy medicines such as carbamazepine, phenytoin and phenobarbital
• Warfarin and aspirin
• Medicines for mental health such as quetiapine, venlafaxine, diazepam and clozapine
• Erythromycin (antibiotic), cimetidine (stomach ulcers), ritonavir (HIV) and colestyramine (cholesterol)
• Malaria medicines mefloquine and chloroquine
• Cannabidiol (CBD) products
• Alcohol and recreational drugs such as cannabis can add to drowsiness or cause anxiety and panic attacks. Tell your doctor or pharmacist about all medicines, herbal remedies and supplements you take.

Always tell your doctor and pharmacist about every medicine, supplement and herbal product you take.

Using it safely

• Read the patient card and leaflet that come with the medicine; the full pack carries the pregnancy warnings.
• Swallow the tablets or capsules whole; do not chew, crush or split them unless the leaflet says you can.
• Taking it with food can help if it upsets your stomach.
• Never stop taking it suddenly unless your doctor tells you to. Stopping suddenly can bring on serious seizures or make mood symptoms worse.
• Stay on the same type and brand once it suits you; switching between types can cause problems.
• Keep all appointments for blood tests and your yearly review.
• It can make you sleepy or dizzy, especially at the start. Do not drive, cycle or use machines until you feel alert.
• If you forget a dose, take it when you remember unless the next one is nearly due. Never take two doses together.
• Keep it out of the reach of children. Too much can cause deep sleepiness, an irregular heartbeat or coma; get emergency help if this happens.

Common questions

Is divalproex sodium the same as sodium valproate?
They are very closely related. Divalproex sodium (valproate semisodium) is a mix of sodium valproate and valproic acid, and the body uses all of them as valproic acid. But they are used in different amounts and sometimes for different conditions, so never swap one for another without your doctor's advice.

Can I take divalproex sodium if I could become pregnant?
Only if there is no other suitable treatment and you follow the pregnancy prevention rules, including effective contraception and a yearly review with your specialist. Valproate can cause birth defects and lifelong learning problems in babies exposed before birth.

What should I do if I find out I am pregnant?
Contact your doctor urgently, but do not stop the medicine on your own. Stopping suddenly can cause serious seizures or a relapse of bipolar disorder, which can harm both you and the baby.

Will it affect my contraceptive pill?
The NHS says valproate does not stop the pill working. But medicines containing oestrogen, including some pills, can lower valproate levels, so your doctor may need to check how well your condition is controlled.

Can I drink alcohol while taking it?
Alcohol can make you more sleepy. It is best to avoid it at first until you know how the medicine affects you.

Prepared from the sources listed by the MedInfoBase team. General information, not medical advice: it gives no doses. Your doctor or pharmacist decides the medicine and dose for you.