Contact the applicable plan ; must be done by the patient herselfContraindicated for use in prophylaxis of migraine headaches in women who are pregnant and in women of childbearing potential who are not using effective contraception; for epilepsy or bipolar disorder, drug should not be used to treat women who are pregnant or who plan to become pregnant unless other medications have failed to provide adequate symptom control or are otherwise unacceptableWomen with epilepsy who become pregnant while taking valproate should not discontinue therapy abruptly, as this can precipitate status epilepticus with resulting maternal and fetal hypoxia and threat to life; discontinuation of the drug may be considered prior to and during pregnancy in individual cases if seizure disorder severity and frequency do not pose serious threat to patientMaternal valproate use during pregnancy for any indication increases risk of congenital malformations, particularly neural tube defects including spina bifida, but also malformations involving other body systems (e.g., craniofacial defects including oral clefts, cardiovascular malformations, hypospadias, limb malformations)Risk is dose-dependent; a threshold dose below which no risk exists cannot be established; valproate polytherapy with other AEDs has been associated with increased frequency of congenital malformations compared with AED monotherapy; risk of major structural abnormalities is greatest during first trimester; however, other serious developmental effects can occur with valproate use throughout pregnancyThere have been reports of hypoglycemia in neonates and fatal cases of hepatic failure in infants following maternal use of valproate during pregnancyPregnant women taking valproate may develop hepatic failure or clotting abnormalities including thrombocytopenia, hypofibrinogenemia, and/or decrease in other coagulation factors, which may result in hemorrhagic complications in the neonate including deathEvidence suggests that folic acid supplementation prior to conception and during the first trimester of pregnancy decreases risk for congenital neural tube defects in general population; not known whether risk of neural tube defects or decreased IQ in offspring of women receiving valproate is reduced by folic acid supplementation; dietary folic acid supplementation both prior to conception and during pregnancy should be routinely recommended for patients using valproateThere have been reports of male infertility coincident with valproate therapy; in animal studies, oral administration at clinically relevant doses resulted in adverse reproductive effects in malesDrug is excreted in human milk; data in the published literature describe presence of valproate in human milk; there are no data to assess effects of drug on milk production or excretionDevelopmental and health benefits of breastfeeding should be considered along with mother’s clinical need for therapy and any potential adverse effects on breastfed child from drug or from underlying maternal conditionMonitor breastfed infant for signs of liver damage including jaundice and unusual bruising or bleeding; there have been reports of hepatic failure and clotting abnormalities in offspring of women who used valproate during pregnancyA: Generally acceptable.

Controlled studies in pregnant women show no evidence of fetal risk.May increase levels of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) in brain; may enhance or mimic action of GABA at postsynaptic receptor sites; may also inhibit sodium and calcium channelsDivalproex sodium is a stable co-ordination compound comprised of sodium valproate and valproic acid in a 1:1 molar relationship and formed during the partial neutralization of valproic acid with 0.5 equivalent of sodium hydroxideEquivalent oral doses of Depakote (divalproex sodium) products and Depakene (valproic acid) capsules deliver equivalent quantities of valproate ion systemically, although the rate of valproate ion absorption may vary with the formulation administered (liquid, solid, or sprinkle), conditions of use (eg, fasting or postprandial) and the method of administrationThese differences should be of minor clinical importancePeak plasma time: 4 hr (tablet); 3.3 hr (sprinkles); 4-17 hr (ER tablet)Protein bound: Concentration dependent; free fraction increases from ~10% at 40 mcg/mL to 18.5% at 130 mcg/mLProtein binding reduced in the elders, chronic hepatic diseases, renal impairment, or with drug that cause displacement (aspirin)CSF: Approximate unbound concentration in plasma (~10% of total concentration) Vd: 11 L/1.73 m2 (total valproate); 92 L/1.73 m2 (free valproate)Divalproex sodium dissociates to the valproate ion in the GI tractValproate metabolized in liver by glucuronidation (30-50%) and mitochondrial beta-oxidation (40%) <15-20% is eliminated by other oxidative mechanismsTotal body clearance: 0.56 L/hr/1.73 m2 (total valproate); 4.6 L/hr/1.73 m2 (free valproate)Adding plans allows you to compare formulary status to other drugs in the same class.To view formulary information first create a list of plans. You cannot take Cialis more than one dose a day. KEPPRA tablets should not be chewed or crushed.Initiate treatment with a daily dose of 1000 mg/day, given as twice-daily dosing (500 mg twice daily).