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This medication, divalproex sodium, has important safety warnings that you should be aware of before starting treatment. Please review the following information carefully and consult your healthcare provider if you have any concerns.

• Liver Problems: Divalproex sodium can cause serious liver issues, which can be life-threatening. The risk is highest during the first six months of treatment. The likelihood of developing liver problems increases for children under 2 years, those with severe seizure disorders, individuals taking multiple seizure medications, and those with certain genetic metabolic disorders. Regular lab tests are recommended to monitor liver function.

• Pancreatitis: Although rare, inflammation of the pancreas has been reported with the use of divalproex sodium. This condition can develop at any time during treatment and can worsen quickly. Symptoms to watch for include persistent nausea, vomiting, abdominal pain, and unusual fatigue. Seek immediate medical attention if these occur.

• Pregnancy Risks: Taking divalproex sodium during pregnancy can lead to birth defects and lower the child's IQ. It may also increase the risk of brain or mental disorders in the child. Women who are pregnant or may become pregnant should discuss alternative treatments and effective birth control with their doctor. It is crucial not to stop the medication abruptly without consulting a healthcare provider, as untreated seizures and mood disorders can harm both the mother and unborn baby. Women are encouraged to enroll in the North American Antiepileptic Drug (NAAED) Pregnancy Registry for monitoring.

• Suicidal Thoughts and Behavior: Like other anti-epileptic drugs, divalproex sodium may increase the risk of suicidal thoughts and behaviors. This risk can appear as early as one week after starting treatment. Patients with a history of depression or suicidal behavior should be closely monitored. Inform your healthcare provider immediately if you or someone you know experiences any suicidal thoughts or actions.

• Blood Disorders: In rare cases, divalproex sodium may lead to lower blood cell counts, increasing the risk of bleeding and bruising. Regular blood tests are essential to monitor blood cell levels. Notify your doctor if you experience unusual bruising or signs of bleeding.

• Ammonia Levels: This medication can cause elevated ammonia levels in the blood, especially when taken with topiramate. Symptoms of high ammonia levels include fatigue, difficulty concentrating, vomiting, and, in severe cases, brain damage. Seek medical help if you notice these symptoms. Divalproex sodium should not be used by individuals with metabolic disorders that increase ammonia levels.

• Severe Skin Reactions: Divalproex sodium may cause severe skin reactions, including rashes, blisters, or peeling skin. These reactions, although rare, can lead to organ failure or blood disorders. If you experience any severe skin reactions, stop taking the medication immediately and consult your healthcare provider.

• Interactions with Other Medications: Divalproex sodium may interact with other drugs, affecting its efficacy and increasing the risk of side effects. Ensure your healthcare provider is aware of all medications you are taking.

Contraindications: This medication should not be used if you have a history of liver problems, certain genetic disorders (such as Alpers-Huttenlocher Syndrome), are under 2 years of age and at risk for genetic disorders, or are pregnant without using contraception. It is also contraindicated for migraine treatment during pregnancy. Always consult with your healthcare provider to determine if this medication is appropriate for you.

When taking this medication, you may experience some common side effects. These can include nausea, dizziness, drowsiness, and vomiting, which are generally mild but should be reported to your healthcare provider if they persist or worsen. Additionally, you might notice changes such as hair loss, blurred or double vision, changes in menstrual periods, ringing in the ears, shakiness, unsteadiness, and weight fluctuations. Rest assured, many individuals using this medication do not experience serious side effects.

However, it is important to be aware of rare but severe side effects that require immediate medical attention. These include symptoms of a severe allergic reaction such as fever, swollen lymph nodes, rash, or trouble breathing. Serious conditions like chest pain, unexplained bleeding, irregular heartbeat, swelling of hands or feet, uncontrolled eye movement, shivering, rapid breathing, or loss of consciousness should prompt urgent medical care.

In rare cases, some individuals may experience mental or mood changes, including depression or suicidal thoughts. If you or those around you notice sudden changes in mood or behavior, notify your healthcare provider immediately. Additionally, severe brain disorders like encephalopathy could occur in patients with certain metabolic conditions, presenting as unexplained weakness, vomiting, or confusion. Always contact your healthcare provider if you experience any unusual or severe symptoms.

When using Divalproex (Depakote), it's important to inform your doctor or pharmacist about all other medications or supplements you are taking, including prescription, over-the-counter, vitamins, and herbal products. This medication can interact with various drugs, potentially affecting how they work or increasing the risk of side effects.

Some common medications that may interact with Divalproex include certain antidepressants like Amitriptyline, Nortriptyline, and phenelzine; antibiotics such as carbapenems including imipenem; and other drugs like Mefloquine, Orlistat, vorinostat, Warfarin, and Zidovudine. Seizure medications such as Ethosuximide, Lamotrigine, Rufinamide, and Topiramate may also interact.

Additionally, substances that cause drowsiness, like alcohol, marijuana (cannabis), antihistamines (e.g., Cetirizine, diphenhydramine), sleep or anxiety medications (e.g., Alprazolam, Zolpidem), muscle relaxants (e.g., Carisoprodol, Cyclobenzaprine), and opioid pain relievers (e.g., codeine, hydrocodone), can enhance this effect when taken with Divalproex.

Always check the labels on your medicines for ingredients that cause drowsiness and consult your pharmacist on how to use these products safely. Be aware that Divalproex can interfere with certain lab tests, such as urine ketones, so ensure your healthcare provider and lab staff are informed about your medication use.