Depacon

US Brand Name: Depacon

Other brand names towards the bottom of the page.

Generic Name: valproate sodium

Other Forms: In the US this comes just as an intravenous injection and as a syrup.  Around the world this is the valproate pill.

FDA Approved Use(s): Monotherapy (used by itself) and adjunctive treatment (i.e. you must use another drug along with it) for a variety of epileptic seizures if you can’t take Depakene(valproic acid) or Depakote (divalproex sodium) capsules. These include complex partial seizures and absence seizures. Depacon is approved for use with epilepsy for adults and children aged 10 and up. An example of a partial seizure is when you’re still conscious and one limb goes completely nuts on you. It’s freaky, believe me. An absence seizure is when you just “go away” for a period of time and you may or may not experience missing time. That is also freaky if you’re ever aware of the damn things.

Around the world valproate sodium is approved to treat a wider array of seizures as well as bipolar disorder and migraines.  Hey, just like Depakote (divalproex sodium) in the US!

Off-Label Uses: Treatment for types of Epilepsy not listed (e.g. tonic-clonic seizures), Borderline Personality Disorder (see also this study), PTSD,  Alcoholism (see also this study), Anxiety (mostly anecdotal evidence and animal studies, no good human studies) and Schizophrenia.

Pros: Proven to be effective for wide spectra of epileptic and bipolar disorders. It’s been around for so long that the long-term effects are well known and well documented. If you can get past the initial side effects and get used to a valproate medication, you don’t have to worry about anything biting your ass in the long run.

Cons: The side effects suck donkey dong! The valproates are amongst the harshest meds to take. Everyone hates them so much that they’ve given the entire class of anticonvulsants a bad name.

Typical Side Effects: The usual for anticonvulsants plus a special set for valproates: instant old age. You’ll get fat, bald, tired, confused, unable to hold your liquor, uninterested in sex and everything will give you heartburn and/or the runs.

Not So Common Side Effects: Twitching, ‘flu-like symptoms, abnormal periods.

These may or may not happen to you don’t, so don’t be surprised one way or the other.

Freaky Rare Side Effects: Bedwetting, reversible dementia and reversible Parkinson’sI told you you’d get instantly old.

You aren’t going to get these. I promise.

Interesting Stuff Your Doctor Probably Won’t Tell You: Taking valproate sodium with food helps reduce a lot of the gastrointestinal problems.

All valproates interact with aspirin. Aspirin prevents you from metabolizing them properly, so you’re better off with ibuprofen.

Your doctor had better damn well be telling you about the regular blood work you need, to check your valproate levels and to make sure your liver is functioning normally.

Dosage: Valproate sodium, like lithium, is all about blood levels.  However none of the PI sheets seemed all that concerned with blood levels.  Dosage was good enough, with blood levels just getting a mention.

Everyone recommends starting at 600mg a day divided into two doses, ramping up by 200mg every three days until your symptoms were under control or you hit 2000 to 2500mg a day (based on weight, allowing 30mg/kg/day).  Although you just might want to check those blood levels to see if you hit that sweet spot between 45 and 125.

Well, at least that’s somewhat saner than the US recommendations for valproates.  But unless you’re really spazzing out, I think you can wait a week between increases.  And you can get blood levels done to see how you’re doing at 600, 800, 1000mg.  And with a half-life of 8-12 hours taking it three times a day would probably work better.  I haven’t found any studies on valproate sodium and TID dosing, just Depakote, but people taking Depakote three times a day seem to complain about some of the side effects less.

Days to Reach a Steady State: Valproate sodium’s non-linear.  You can’t pin down a hard number on it. I haven’t found a number for it in any study.  Based on the usual formula of 6 * half-life, approximately three days.

When you’re fully saturated with the medication and less prone to peaks and valleys of effects. You still might have peaks of effect after taking many meds, but with a lot of the meds you’ll have fewer valleys after this point. In theory anyway.

How Long it Takes to Work: In theory you should start feeling results once you’re in the therapeutic range of your blood levels. So for epilepsy that’s generally in the neighborhood of 50-100, and for bipolar it’s a wider range of 40-150. Getting to that blood level is between you and your liver. Once there it’s up to your brain if it’s going to respond to a valproate or not. So unlike most anticonvulsants where you feel something in a matter of days, or there’s a definite dosage where we can write, “here is where you should notice effect or not,” it’s just not like that with the valproates. So once you’re there, here’s a study with PET scans indicating 2-6 weeks to start feeling something.

Half-Life & Average Time to Clear Out of Your System: 8-12 hours. You should thus step down the dosage by however much you increased it (keep good records about that!) a day every two to three days.

Like any anticonvulsant, if you’ve been taking valproate sodium for more than a couple months and you’ve reached the therapeutic blood levels, you just can’t stop cold turkey if you’re not at the therapeutic dosage for another anticonvulsant that is known to work for you, otherwise you risk partial onset or absence seizures to tonic-clonic grand mals, even if you’ve never had a seizure disorder before!  The risk is worse if you’re taking a lithium variant, and/or any antidepressant, especially Wellbutrin. Anyone with a history of a seizure disorder who needs to stop taking an anticonvulsant cold turkey needs to be discussing that with two neurologists and not getting your information from some stupid web site. Get off your computer and start making appointments!

If you’ve worked your way up to a particular dosage, it’s usually best to spend this many days at the next lowest dosage before going down the next lowest dosage before that and so forth. This is the least sucky way to avoid problems when stopping any psychiatric medication. Presuming you have the option of slowly tapering off them.

Other Brand Names: Convulex (Germany), Convulex Syrup (South Africa),
Depakene (Japan)
Depakin (Bulgaria; Turkey)
Depakine (Austria; Bahrain; Belgium; Cyprus; Egypt; France; Greece; Hungary; Iran; Iraq; Jordan; Korea; Kuwait; Lebanon; Libya; Netherlands; Oman; Portugal; Qatar; Republic of Yemen; Saudi Arabia; Spain; Switzerland; Syria; Thailand; United Arab Emirates)
Depakine Chrono (Belgium; Hungary; Poland; Portugal; Taiwan; Thailand)
Depakine Druppels (Netherlands)
Depakote (France)
Depalept (Israel)
Depalept Chrono (Israel)
Epilam (Korea)
Epilex (Turkey)
Epilim (Australia; Bahamas; Barbados; Belize; Benin; Bermuda; Burkina Faso; China; Curacao; England; Ethiopia; Gambia; Ghana; Guinea; Guyana; Hong Kong; Ireland; Ivory Coast; Jamaica; Kenya; Kuwait; Liberia; Libya Lebanon; Malawi; Malaysia; Mali; Mauritania; Mauritius; Morocco; Dutch Antilles; New Zealand; Niger; Nigeria; Oman; Qatar; Republic of Yemen; Saudi Arabia; Senegal; Seychelles; Sierra Leone; South Africa; Sudan; Surinam; Syria; Tanzania; Trinidad; Tunisia; Uganda; United Arab Emirates; Zambia; Zimbabwe)
Epilim Chrono (Malaysia)
Epival (Bahrain; Costa Rica; Cyprus; Dominican Republic; Egypt; El Salvador; Guatemala; Honduras; Iran; Iraq; Jordan; Kuwait; Lebanon; Libya; Nicaragua; Oman; Panama; Qatar; Republic of Yemen; Saudi Arabia; Syria; United Arab Emirates)
Leptilan (Bahamas; Barbados; Belize; Benin; Bermuda; Burkina Faso; Curacao; Ecuador; Ethiopia; Gambia; Ghana; Guinea; Guyana; Indonesia; Ivory Coast; Jamaica; Kenya; Kuwait; Liberia; Libya Lebanon; Malawi; Malaysia; Mali; Mauritania; Mauritius; Mexico; Morocco; Dutch Antilles; Niger; Nigeria; Oman; Qatar; Republic of Yemen; Saudi Arabia; Senegal; Seychelles; Sierra Leone; Sudan; Surinam; Syria; Taiwan; Tanzania; Trinidad; Tunisia; Uganda; United Arab Emirates; Zambia; Zimbabwe)
Orfil (Korea)
Orfiril (Hong Kong; Israel; Peru)
Orfiril Retard (Singapore)
Petilin (Bahamas; Bahrain; Barbados; Belize; Benin; Bermuda; Burkina Faso; Curacao; Cyprus; Egypt; Ethiopia; Gambia; Ghana; Guinea; Guyana; Iran; Iraq; Ivory Coast; Jamaica; Jordan; Kenya; Kuwait; Kuwait; Lebanon; Liberia; Libya; Libya Lebanon; Malawi; Mali; Mauritania; Mauritius; Morocco; Dutch Antilles; Niger; Nigeria; Oman; Oman; Qatar;  Republic of Yemen; Republic of Yemen; Saudi Arabia; Saudi Arabia; Senegal; Seychelles; Sierra Leone; Sudan; Surinam; Syria; Syria; Tanzania; Trinidad; Tunisia; Uganda; United Arab Emirates; United Arab Emirates; Zambia; Zimbabwe)
Valcote (Ecuador)
Valeptol (Korea)
Valoin (Korea)
Valpakine (Costa Rica; Dominican Republic; Ecuador; El Salvador; Guatemala; Honduras; Peru)
Valparin (Thailand)
Valporal (Israel)
Valprax (Peru)
Valpro (Australia; Hong Kong)
Valsup (Colombia)
Comments: Be sure to read the sections on anticonvulsants and valproate drugs if you haven’t done so already.
While not used very much in the US, valproate sodium is the bomb around the world as a first-line medication for epilepsy and bipolar disorder. In the US this is the oddball of the valproate family, reserved for people who can’t take pills or sprinkle capsules, and the intravenous form can be used for the dread status epilepticus. While that review indicates it’s not a first-line treatment for status epilepticus, another shows that for some forms you may want to break out the sodium valproate first. And it is being studied for a wide array of other disorders. It’s been used to treat bipolar disorder for twenty years and epilepsy for over thirty. It’s been evaluated for schizophrenia, both as a way just to treat the symptoms of the illness and as a way to deal with tardive dyskinesia. However other studies and a review of GABAergic meds in general is that as a treatment for TD the data are inconclusive. Other anticonvulsants are being evaluated for schizophrenia, so there still may be something to using valproate sodium or another anticonvulsant.

As this is a more global med than Depakote there are probably a lot more studies out there for a lot more problems, but as they aren’t in English I’m not seeing them.

As for dealing with those awful side effects:
Valproate sodium has been tested with every known antacid, because, you know, valproates mess with your stomach so much. Aluminium and magnesium hydroxides can cause you to get more valproate sodium than you were before – so watch out!
I had hoped to provide all y’all with something to give you some hope on the hair-loss front. Sorry. Nutritional supplements usually don’t do squat for hair loss. There was one letter published in an obscure journal which may state just the opposite when it comes to Depakote, but it’s not online so I don’t have a clue. Here’s the cite if you want to dig it up yourself.
For the lethargy, like all anticonvulsants the only safe thing to counter it seems to be Provigil (modafinil). Everything else is just too likely to trigger either mania or seizures.
Beta blockers like Inderal have been used to counter the tremors associated with lithium. I haven’t seen a reference to their being used with valproates.
The weight gain is going to suck. Diet and exercise are going to do only so much, and everyone is going to give you shit about how lazy and weak-willed you are for gaining weight when it’s the pills that are causing the weight gain! Yet every pill out there that can counter that weight gain is most likely a no-no. Diet pills that work will trigger seizures and/or manias. Anticonvulsants with weight loss as a side effect such as Topamax (topiramate) or Zonegran (zonisamide) may be inappropriate for you and make you worse, not better. There are some wacky alternatives thought that may work out. They are a bit strange, and will require careful consultation with your doctor. They are also unlikely to be covered by any form of insurance.
The anti-Alzheimer’s medications Exelon (rivastigmaine tartrate) and Aricept (donepezil hydrochloride). You need take one or the other. These are a two-fer, as they help deal with the memory issues and fuzzy-headedness that come with anticonvulsants. They also frequently cause weight loss. Like Zonegran (zonisamide) this happens more often for women than men. Go figure.
Symmetrel is an antiviral and anti-Parinkson’s medication. There was one small study done on its effects reversing the weight gain caused by Zyprexa (olanzapine). While it may not help with any cognitive issues, at least it has a study backing it up that it doesn’t fuck up the benefits of a psychiatric med. I’ll keep all y’all posted if I find out any more about this med and the whole weight issue in general on a separate article about weight and meds.
There’s not much that I know of that you can do for your liver. Oh sure, there’s that wonderful milk thistle (silymarin) and the amino acid NAC. There are just two big problems with those:
Like any supplements you don’t know if you’re getting the real thing or not.
When you do get the real thing, they work. They work too well. Milk thistle extract has been used to save people who have eaten the wrong type of amanita mushroom. So what does that mean to someone taking a med like valproate sodium that is heavily processed by your liver? It means that the milk thistle and NAC flush the valproate sodium out of your liver before it gets metabolized! So, yeah, your liver gets cleaned out all right, and your valproate sodium doesn’t work! There has been one double-blind study involving silymarin and Haldol [1] indicating that, yeah, the milk thistle helped prevent liver toxicity, but at what cost to the efficacy of the psychiatric meds? The doctor who is treating me for environmental sensitivities who had me taking the milk thistle and NAC advised me to stop when I began a course of psychiatric meds, otherwise I’d just have to take more meds, and that would be counterproductive.

 

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