Trying to understand the effects Depakote has on the human body?… by tammyjackl
15 yr old girl with epilepsy.
Has been on Depakote for 9 years.
Weight 101 pounds/Height 5'6
Taking 2,000 mg daily and still testing only a level 10 in blood work. Also on Lamictal for 1 year.
Why are the blood levels still testing this low?
The bone lose, what can be done to revert it, while still taking the drug?
Best Answer:
Common side effects
Dose-related side effects
Depakote is one of the standard epilepsy medicines, and many people who take Depakote (and the other forms of valproate) experience few side effects and enjoy improved control of their seizures. The most common side effects include:
tiredness
dizziness
nausea
vomiting
tremor
hair loss
weight gain
behavioral changes (depression in adults, irritability in children)
Some other side effects mentioned even less often are:
elevated blood ammonia levels, suggested by sleepiness, headache, confusion, or nausea
reduced attentiveness and response accuracy
Tiredness occurs in many individuals and is often associated with high doses and blood levels. Tiredness can include a range of effects, including slower mental processing speed and less “perkiness” and “spontaneity” in behavior. Large reductions in mental processing speed are uncommon. Effects on “motivation” and “perkiness” are very hard to measure, but they are usually mild and are not common. Patients with new prescriptions for Depakote should be advised to be careful with driving and similar activities until they know whether their abilities are affected.
Nausea is common when therapy begins but is usually less troublesome with Depakote or Depakote ER than with Depakene. Starting at a very low dosage or taking the medicine on a full stomach may help to reduce nausea. Vomiting is less common but occurs in susceptible individuals. Stomach upset from Depakote is more likely when another medication with similar side effects (for example, carbamazepine or felbamate) is also being used.
Tremor is related to blood level and individual susceptibility. Usually the tremor is a fine, rapid intention tremor. Large, slow tremors can also occur, however, sometimes at rest. The tremors tend to fluctuate widely over the course of the day, probably reflecting fluctuations in valproate blood levels as well as other factors that worsen tremor, such as anxiety, caffeine, or low blood sugar. If Depakote is critical for achieving seizure control in a particular patient but the tremor is troublesome, drugs to treat tremor (such as propranolol or primidone [Mysoline]) may be used. These may contribute to other side effects, however.
Weight gain is one of the most vexing side effects of Depakote, affecting 30% to 50% of patients. It is more common in adult women but it also affects men and sometimes even children. Studies suggest that both increased appetite and decreased metabolism can contribute. The average gain for adults is 15 pounds. Exercise and a reduced-calorie diet can be very helpful. It remains uncertain whether weight gain is greater when higher doses of Depakote are taken.
Hair loss occurs in 5% to 10% of patients taking Depakote. It is uncertain whether more hair is lost when higher doses of Depakote are taken. The hair almost always grows back after the Depakote is stopped, but it often has a different texture. (For example, it may grow in curly instead of straight.) Taking selenium (10-20 mcg per day) and zinc (25-50 mg per day) helps some people to prevent hair loss.
Long-term use of valproate has been linked to bone loss, ankle swelling, irregular menstruation, and polycystic ovary syndrome (PCOS). Taking supplements of both calcium and vitamin D may help to prevent bone loss. Patients who have taken Depekote or other forms of valproate for more than 5 years may be advised to have a bone density test. If the test shows significant thinning of the bones, referral to a bone metabolism specialist may be indicated.
Idiosyncratic reactions
Allergic reactions such as rashes are less common with Depakote and other forms of valproate than with most other antiepileptic drugs. Patients should be advised to report rashes, however, especially early in the course of treatment.
Some other rare but life-threatening disorders do occur with the use of this medication. Children younger than 2 years of age and those taking other seizure medications in addition to Depakote are at highest risk. See Serious side effects
Serious side effects of Depakote
Most side effects from taking Depakote go away with no lasting harm. But a few people have serious reactions that can even be life-threatening.
Here's a list of symptoms that may be the start of one of these problems. Advise patients to call immediately if they notice any of these symptoms:
weakness, lethargy, facial edema, anorexia, vomiting, jaundice, especially in a child under 2 years of age (possible liver failure)
abdominal pain, nausea, vomiting, and/or loss of appetite (possible pancreatitis)
easy bruising, nosebleed, other abnormal bleeding (problems with clotting)
The best-known and most feared serious reaction is liver damage, which has been fatal in some patients. This damage usually occurs within the first 6 months of treatment. The risk of liver failure is much higher in children under 2 years of age, especially if they are also taking other antiepileptic drugs or if they have a congenital metabolic disorder, a severe seizure disorder with mental retardation, or other brain disease. Consult a pediatric epileptologist before prescribing Depakote for a child who meets these criteria. The risk of liver failure is much lower in children between 2 and 10 and is very low in older children and adults, perhaps 1 in 50,000. This is similar to the frequency of liver failure when taking other medications such as phenytoin. Depakote can deplete the liver's stores of carnitine, and some believe that taking extra carnitine can help prevent the rare cases of liver damage. There is no clear evidence of this effect. Carnitine supplements should be considered only for those at highest risk. There is no evidence that long-term use of Depakote will cause gradual, progressive damage to liver function.
Another rare but potentially life-threatening reaction to Depakote is pancreatitis, which occasionally progresses to bleeding and death. This reaction may occur in both children and adults, even after several years of therapy with Depakote. Advise patients to report promptly the symptoms listed above.
Clotting problems-thrombocytopenia or impaired platelet function-are more likely to occur when high doses of Depakote are taken. Sometimes these problems return to normal without stopping the medication. A complete blood count, thrombocyte count, and coagulation testing should be performed before and after the initiation of treatment with Depakote and before elective surgery.
When a patient presents with a serious and/or unexpected adverse reaction from a medication or device, you should consider reporting this event to Medwatch (http://www.fda.gov/medwatch/report/hcp.htm). To download Medwatch reporting forms click here (http://www.fda.gov/medwatch/getforms.htm).
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