Depakote side effects in elderly

Depakote Oral: Uses, Side Effects, Interactions, Pictures, Warnings & Dosing

Warnings:

Rarely, this medication has caused serious (sometimes fatal) liver problems, usually within the first 6 months of starting treatment. Laboratory tests should be performed before you start treatment and periodically during treatment, especially within the first 6 months, to monitor this side effect.

The risk of serious liver problems is increased in children younger than 2 years, especially if they have an inherited metabolic disorder, severe seizure disorder with mental retardation, organic brain disease, or if they take more than one seizure medication. Talk with the doctor about the risks and benefits of using this medication in children younger than 2 years.

Due to an increased risk for liver problems, people with certain inherited metabolic disorders (such as Alpers-Huttenlocher syndrome) should not use this medication. Children younger than 2 years who might have these disorders should not use this medication. Children older than 2 years who might have these disorders should be closely monitored during treatment with divalproex sodium. Talk to your doctor for details.

This medication has rarely caused severe (sometimes fatal) disease of the pancreas (pancreatitis). This may occur at any time during treatment and can quickly worsen.

Tell your doctor right away if you develop symptoms of liver problems or pancreatitis such as nausea/vomiting that doesn't stop, unusual tiredness, weakness, swelling of the face, stomach/abdominal pain, loss of appetite, dark urine, or yellowing eyes/skin.

Taking this medication during pregnancy can cause birth defects, may lower your child's IQ, and may increase the risk of your child having certain brain/mental disorders (such as autism, attention deficit/hyperactivity disorder). Women of childbearing age should discuss the risks and benefits of this medication, other treatment options, and use of reliable forms of birth control with their doctor. If you are planning pregnancy, become pregnant, or think you may be pregnant, immediately talk to your doctor. If you are taking divalproex sodium only to prevent migraine headaches, this medication must not be used during pregnancy. If you are taking divalproex sodium to treat seizures or mental/mood problems (such as bipolar disorder), do not stop taking this medication unless directed by your doctor. Untreated seizures and mental/mood problems (such as bipolar disorder) are serious conditions that can harm both a pregnant woman and her unborn baby.

Warnings:

This medication has rarely caused severe (sometimes fatal) disease of the pancreas (pancreatitis). This may occur at any time during treatment and can quickly worsen.

Uses

This medication is used to treat seizure disorders, certain psychiatric conditions (manic phase of bipolar disorder), and to prevent migraine headaches. It works by restoring the balance of certain natural substances (neurotransmitters) in the brain.

How to use Depakote

Read the Medication Guide and, if available, the Patient Information Leaflet provided by your pharmacist before you start taking divalproex sodium and each time you get a refill. If you have any questions, ask your doctor or pharmacist.

Take this medication by mouth as directed by your doctor. You may take it with food if stomach upset occurs. Swallow the tablet whole. Do not crush or chew the tablet, which can irritate the mouth or throat.

The dosage is based on your age, weight, medical condition, response to treatment, and other medications you may be taking. Be sure to tell your doctor and pharmacist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products). Use this medication regularly in order to get the most benefit from it. Remember to use it at the same time each day to keep the amount of medication in your blood constant.

If this medication is used for seizures, do not stop taking it without consulting your doctor. Your condition may become worse if the drug is suddenly stopped. Your dose may need to be gradually decreased.

Divalproex sodium does not relieve acute migraine headaches. Take other medications as directed by your doctor for acute attacks.

Inform your doctor if your condition does not improve.

Side Effects

Precautions

Interactions

Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.

Some products that may interact with this drug include: certain antidepressants (such as amitriptyline, nortriptyline, phenelzine), certain antibiotics (carbapenems such as imipenem), irinotecan, mefloquine, orlistat, other medications for seizure (such as ethosuximide, lamotrigine, rufinamide, topiramate), warfarin, vorinostat, zidovudine.

Low-dose aspirin, as prescribed by your doctor for specific medical reasons such as heart attack or stroke prevention (usually 81-162 milligrams a day), should be continued. Consult your doctor or pharmacist if you are using aspirin for any reason.

Tell your doctor or pharmacist if you are taking other products that cause drowsiness including alcohol, marijuana (cannabis), antihistamines (such as cetirizine, diphenhydramine), drugs for sleep or anxiety (such as alprazolam, zolpidem), muscle relaxants (such as carisoprodol, cyclobenzaprine), and opioid pain relievers (such as codeine, hydrocodone).

Check the labels on all your medicines (such as allergy or cough-and-cold products) because they may contain ingredients that cause drowsiness. Ask your pharmacist about using those products safely.

This drug may affect certain lab tests (such as urine ketones). Make sure laboratory personnel and your doctors know you use this medication.

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Overdose

If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: excessive drowsiness, coma, irregular/slow heartbeat.

Do not share this medication with others.

Lab and/or medical tests (such as drug levels, liver function, complete blood counts, clotting tests) should be done before you start taking this medication and while you are taking it. Keep all medical and lab appointments. Consult your doctor for more details.

If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.

Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.

Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

Images

Depakote 125 mg tablet,delayed release

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This medicine is a salmon pink, oval, coated, tablet imprinted with "logo and NT".

Depakote 500 mg tablet,delayed release

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This medicine is a salmon pink, oval, coated, tablet imprinted with "logo and NT".

Depakote 500 mg tablet,delayed release

Color: lavenderShape: ovalImprint: logo and NS

This medicine is a salmon pink, oval, coated, tablet imprinted with "logo and NT".

Depakote 250 mg tablet,delayed release

Color: peachShape: ovalImprint: logo and NR

This medicine is a salmon pink, oval, coated, tablet imprinted with "logo and NT".

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Selected from data included with permission and copyrighted by First Databank, Inc. This copyrighted material has been downloaded from a licensed data provider and is not for distribution, except as may be authorized by the applicable terms of use.

CONDITIONS OF USE: The information in this database is intended to supplement, not substitute for, the expertise and judgment of healthcare professionals. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or anyone else. A healthcare professional should be consulted before taking any drug, changing any diet or commencing or discontinuing any course of treatment.

Frequently asked questions (FAQs) | Depakote® (divalproex sodium)

A: Common side effects experienced with Depakote include drowsiness, nausea, abdominal pain, diarrhea, vomiting, low platelet count, tremors, tiredness, and hair loss. The side effects may be mild to moderate, but they may also be signs of a more serious condition. You should talk to your doctor about any side effects you may experience. Please see Full Prescribing Information with Medication Guide for the complete list of side effects.

A: The following serious side effects are associated with Depakote:

Serious liver damage that can cause death, especially in children younger than 2 years old. Risk of serious liver damage is more likely to occur within the first 6 months of treatment, and may continue despite discontinued use of the drug. Call your doctor right away if you experience any of the following symptoms:

Nausea or vomiting that does not go away
Loss of appetite
Pain on the right side of your stomach (abdomen)
Dark urine
Swelling of your face
Yellowing of your skin or the whites of your eyes

Inflammation of your pancreas that can cause death. Call your healthcare provider right away if you have any of these symptoms:

Severe stomach pain that you may also feel in your back
Nausea or vomiting that does not go away

Taking Depakote during pregnancy can harm your unborn baby; increasing the risk of serious birth defects [e. g. brain, spinal cord (spina bifida), heart, head, arms, legs and penis] and the risk of your child having a lower IQ. Call your doctor if you are pregnant or become pregnant.

Women taking Depakote should use an effective birth control and talk with their doctor about the best birth control method for them.

Suicidal thoughts or actions in a very small number of people, about 1 in 500. Call a healthcare provider right away if you have any of these symptoms, especially if they are new, worse, or worry you:

Thoughts about suicide or dying
Attempts to commit suicide
New or worse depression
New or worse anxiety
Feeling agitated or restless
Panic attacks
Trouble sleeping (insomnia)
New or worse irritability
Acting aggressive, being angry, or violent
Acting on dangerous impulses
An extreme increase in activity and talking (mania)
Other unusual changes in behavior or mood

Overall, pay attention to any symptom changes, especially sudden changes in mood, behaviors, thoughts, or feelings. Keep all follow-up visits with your doctor as scheduled, and call between visits as needed, especially if you are worried about symptoms. Please see Full Prescribing Information with Medication Guide for the complete list of side effects.

A: Depakote can have potentially important interactions with certain medicines. Talk to your doctor or pharmacist if you have concerns about Depakote and other medications you are currently taking, including those without a prescription, vitamins, and herbal products. Please see Full Prescribing Information with Medication Guide for the complete list of side effects.

A: As with all medications, Depakote should be kept in a safe place, tightly closed, and out of reach of children. Depakote should be stored at room temperature. Depakote should not be stored above 86° F. Do not keep it in the refrigerator. The pharmacy bottle or pillbox should be protected from light or moisture. Do not store it in a damp place like a bathroom medicine cabinet. Please see Full Prescribing Information with Medication Guide for the complete list of side effects.

A: If you forget to take your daily dose of medicine at the scheduled time, go ahead and take it as soon as you remember. However, if it’s almost time for you to take your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take a double dose. If you have any questions, please call your doctor. Please see Full Prescribing Information with Medication Guide for the complete list of side effects.

Drug problems in the elderly

Most people over the age of 50 have to take many different drugs to treat and prevent accumulated diseases. Confusion arises: what to drink, once a day, at what time, before or after meals, and for how long. It's pretty hard to keep everything in your head. In addition, all drugs have contraindications. As a result, it often turns out that drugs for one disease aggravate another, the treatment is ineffective and does more harm than good. Why is this happening and what are the main causes of problems in taking medications in older people?

Similarity of disease symptoms and drug side effects

In old age, the side effects of some drugs can be confused with the symptoms of illnesses, such as dementia. Therefore, it can be quite difficult to determine whether new symptoms are a new disease or a side effect. This leads to the so-called assignment cascade. The attending physician prescribes medication to the patient for new symptoms instead of replacing the drug that causes side effects. The newly prescribed drug has its own side effects, from which new drugs are prescribed again ... As a result, an overabundance of medicines appears, the patient's body experiences great stress and, as a result, instead of improving, the state of health worsens.

Often the prescription cascade begins with antipsychotics (drugs for mental disorders). They have a side effect that is similar in symptoms to Parkinson's disease, which is quite common in old age. In this case, the appointment of antiparkinsonian drugs with a high degree of probability will lead to the appearance of delirium and nausea in the patient. And the treatment of these symptoms to problems with digestion and pressure.

In a group of dementia drugs called cholinesterase inhibitors, which include drugs such as Rivastigmine and Galantamine, side effects can include urinary incontinence, frequent urination, and diarrhea.

The joint use of medicines, folk remedies and dietary supplements also leads to undesirable consequences and side effects. The patient may forget to tell the doctor that he is drinking this or that infusion of herbs, and as a result get unpleasant side effects: dizziness, bleeding, etc.

In addition, the presence of the same side effect in different drugs can lead to an additional risk of its manifestation, and in a rather high degree of intensity. Therefore, when prescribing treatment, the therapist must know exactly what medications and non-pharmacological drugs you are taking.

Doctor does not have a complete list of medications taken

One of the causes of problems in the elderly when using drugs is the lack of a complete list of drugs taken by the patient from the attending physician. The attending physician should maintain such a list, periodically review it and review it before prescribing new drugs.

Taking into account the change in the patient's condition and the assessment of the interaction of various drugs, the doctor should also adjust the dosage and duration of the drugs. The patient should, accordingly, carry out treatment only with prescribed drugs and not self-medicate.

Incorrect prescribing of drugs to elderly patients

If the harm from the drug for the patient is greater than the benefits, or if its inclusion in the complex of drugs taken by the elderly person worsens his condition, then the appointment of such a drug is incorrect.

Incorrect prescribing of the drug can also be expressed in the wrong dosage and frequency of administration. Another common occurrence is an increase in the duration of taking the drug. For example, a drug was prescribed to a patient for the treatment of an acute condition and was not withdrawn after relief.

Various drugs may work for adults aged 18 to 50 but are dangerous or undesirable for older people. The acceptability of certain drugs for an elderly person can be determined using the Beer criteria developed by American scientists. According to them, all groups of medicines are classified according to the degree of acceptability for the elderly, indicating possible replacement options.

However, the problem with incorrect prescribing of drugs is quite common. According to statistics, about 27% of deaths of older people occur precisely as a result of such appointments. Especially often, various analgesics, laxatives or hypnotics are incorrectly prescribed, instead of eliminating the health problems that have arisen with non-drugs (massage, exercise, physiotherapy) or canceling the drug that has the corresponding side effect.

Therefore, it is very important that the doctor be able to analyze the entire list of medications taken before prescribing drugs and be guided by the ratio of benefits and risks of prescribing for each patient individually.

Patient non-compliance with medications

Violation of the regimen of intake or dosage occurs in almost half of the cases of treatment of older people. This happens due to natural causes: forgetfulness, absent-mindedness, etc. As a result, the concentration of the drug in the body decreases and the expected therapeutic effect does not occur.

Do not forget to take drugs during the day, special containers for drugs help, in which daily doses of drugs can be laid out. It is enough to decompose the medicines once and take them correctly all day. Another option is to attach homemade instructions to the medicine package, written in large print, which clearly states the regimen and dosage prescribed by the doctor. Such simple methods help to conduct correct and timely treatment.

Refusal to buy an expensive drug due to financial difficulties

In addition to the causes of drug abuse discussed above, some older people may also have financial problems. Not all pensioners can afford to buy expensive medicines, but they are embarrassed to tell the doctor about it, and they themselves either do not take the right drug, or get a cheaper analogue that can have a completely different spectrum of action, side effects and have a completely different effect on the body. Therefore, there is no need to be shy. If the doctor knows that your financial resources are limited, he will be able to choose the correct replacement for the necessary drug or write a prescription for its free receipt.

Overdose

The doctor may not take into account the age characteristics of the patient and prescribe too high a dosage of the drug to obtain a faster effect. However, in old age, this is not the case. The body of an elderly person is very sensitive to external influences, and the metabolism is slowed down. Therefore, the appointment of the drug for an elderly person should always begin with minimal dosages.
Overdose can also occur due to drug interactions. For example, if different doctors have prescribed the same drug, and also if different drugs have a similar therapeutic effect.

Undertreatment

Trying not to harm, the doctor may prescribe an insufficient dose of the drug to achieve the maximum effect. Unfortunately, such caution can cause serious consequences for the quality of life and health of an elderly person, and sometimes even death.

Most often, underdosing of drugs is prescribed to older people for depression, Alzheimer's disease, heart failure, and some other diseases. It is also not uncommon to prescribe underdose opioids to patients who need them, such as cancer patients. Doctors are afraid of the addiction effect in the patient, and as a result, he experiences excruciating pain and discomfort. The same story occurs with the appointment of anticoagulants. This group of drugs reduces the risk of stroke in patients with atrial fibrillation. And yet, for many patients, doctors do not prescribe them because of the high risk of bleeding.

Insufficient dosages may also be prescribed by the doctor because he may be afraid of the financial burden on the patient or because the patient often exaggerates the effect of the treatment. Therefore, it is important to actively participate in the formation of the list of drugs, expressing your priorities and opportunities.

Taking medications by the elderly is a rather complicated process that requires particularly careful attention from both the attending physician and the patient. In order to really feel the improvement, and not harm yourself, you should always have a list of all the medicines you take with you at the doctor’s appointment, accurately and objectively talk about your well-being and clearly indicate your physical and financial capabilities.

Olga Pasynkova, Candidate of Medical Sciences, Chief Freelance Specialist in Clinical Pharmacology of the Ministry of Health of the Republic of Mari El, talks about changes in the body of an elderly person that change the response to drugs.

The elderly are more sensitive to the side effects of drugs, the incidence of which in outpatient practice is 10 times higher compared to inpatients, although hospitalization is a significant risk factor for adverse drug reactions.

Side effects in the elderly are most often manifested in the form of non-specific reactions - cognitive disorders and falls, so they are often unrecognized. Among people over 65 years of age, drug-associated mortality ranks 9th among the causes of death. What could be the reason for the dramatic increase in drug side effects?

First, the functional reserves of the liver and kidneys are reduced in the elderly, which slows down the excretion of medicinal substances and increases the average concentration of the drug in the blood.

Secondly, patients of the older age group often suffer from comorbidities and are forced to receive diverse treatment, which increases the drug load. According to researchers, more than 2/3 of the elderly receive more than 6 drugs per day. It has been established that an increase in the number of simultaneously taken drugs increases the risk of drug interactions exponentially. When taking 10 drugs at the same time, the probability of their development approaches 100%.

Drug interactions can have various consequences. The use of drugs in conjunction with rifampicin, phenobarbital, carbamazepine, as a rule, is accompanied by a weakening of their effect. For example, in the case of constant use of cardiac preparations of acetylsalicylic acid, it is better to avoid corvalol, valocardine, pentalgin and other drugs containing phenobarbital. Some drugs, such as clarithromycin, erythromycin, antifungal drugs, on the contrary, slow down the metabolism of the drugs used together and can lead to severe drug reactions. So, fluconazole promotes an increase in the concentration of certain hypoglycemic drugs, which increases the likelihood of developing hypoglycemia.

Medicines interact not only with each other, but also with food. For example, a glass of grapefruit juice can neutralize the action of one of the main enzymes that metabolize simvastatin for 3 days.

It is impossible to be careless about phytotherapy. Some medicinal herbs can interfere with the effects of medications taken together. For example, St. John's wort reduces the effectiveness of many drugs.

On the other hand, in the elderly, the structure and number of target receptors, that is, the points of application of the drug, change, which disrupts the therapeutic response of the body. Therefore, the outcome of treatment in an elderly person is difficult to predict. For example, the effect of tumor necrosis factor inhibitors in the elderly is less pronounced. Elderly patients with arterial hypertension are less responsive to treatment with beta-blockers, but they have a more pronounced hypotensive effect of thiazide and thiazide-like diuretics.

Although the use of cardiac drugs prolongs the life of elderly patients, the effect is not as great as in younger individuals. The risks associated with taking some drugs in old age may outweigh the benefits of treatment. The use of such drugs should be limited.

This is also true for systemic non-steroidal anti-inflammatory drugs (NSAIDs). They not only lead to various disorders of the gastrointestinal tract, but also can provoke a stroke, myocardial infarction, aggravate the course of arterial hypertension and impair kidney function. Therefore, they should be used at the lowest effective dose for the shortest period of time. And, if possible, replace systemic NSAIDs with paracetamol and topical NSAIDs.

It is necessary to pay special attention to non-drug methods of treatment of the elderly. It is important to maintain the level of physical activity, give up bad habits (smoking and alcohol), limit the intake of salt, animal fats, and correctly alternate work and rest.

Separately, we will touch on the methods of physio- and hardware treatment. On the one hand, they can have a good effect and reduce the drug load. On the other hand, they have their own contraindications, which we may not be aware of. Therefore, before using them, a doctor's consultation is always required.

Thus, the selection of treatment in geriatric practice is associated with a painstaking search for the most appropriate drug in the minimum effective dosage, taking into account comorbidity.

The developed recommendations and standards of treatment in the vast majority of cases do not take into account the age of the patient, the presence of several diseases and the need to use combination therapy. When choosing a drug for an elderly patient, it is not always possible to rely on the results of studies, they are sometimes not applicable to the elderly.

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Depakote side effects in elderly

Depakote Oral: Uses, Side Effects, Interactions, Pictures, Warnings & Dosing

Uses

How to use Depakote

Side Effects

Precautions

Interactions

Overdose

Images

Save up to 80% on your prescriptions.

Available coupons

Save up to 80% on your prescription with WebMDRx

Are you currently using Depakote?

Frequently asked questions (FAQs) | Depakote® (divalproex sodium)

Drug problems in the elderly

Similarity of disease symptoms and drug side effects

Doctor does not have a complete list of medications taken

Incorrect prescribing of drugs to elderly patients

Patient non-compliance with medications

Refusal to buy an expensive drug due to financial difficulties

Overdose

Undertreatment

Olga Pasynkova, Candidate of Medical Sciences, Chief Freelance Specialist in Clinical Pharmacology of the Ministry of Health of the Republic of Mari El, talks about changes in the body of an elderly person that change the response to drugs.