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Tips for tapering off sodium valproate and valproic acid (divalproex sodium, Depakote, Depakene)

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ADMIN NOTE As there are many forms of sodium valproate, tapering will be highly individual. If you wish peer counseling for your taper, please start a topic for yourself in the Introductions forum.

 

If you have been prescribed any form of sodium valproate for symptoms that were interpreted as psychotic, you will need to be especially careful to taper slowly, only as fast as your nervous system can remain calm.

 

Under any circumstances, you will want to keep your nervous system stable and avoid hospitalization. If the stress of withdrawal triggers unusual symptoms again, you may be re-medicated with even higher doses of an antipsychotic.

 

You may be able to minimize your drug burden or even go off drugs completely, but you will need to taper very carefully, heed any warning signs and, if you hit a rough spot, possibly halt tapering, at least for a while. If you've lowered the dosage, you've reduced the risk of the drug to your general health.

 

Be sure to read Why taper by 10% of my dosage?

 


 

Sodium valproate, valproic acid, mixtures of the two, valproate semisodium, or divalproex sodium aka Depakote, Depakote DR, Depakote ER, Depakote Sprinkles, Alti-Valproic, Depakene, Depakene Crono, Depacon, Depakine, Valparin, Stavzor, Depakin, Apo-Divalproex, Apo-Valproic Acid, Epival, Gen-Valproic, Nu-Divalproex, PMS-Valproic Acid, PMS-Valproic Acid E.C., ratio-Valproic, Sandoz Valproic, Stavzor, Convulex, Deprakine, Encorate, Epival, Epilim, Valcote

 

More information at http://en.wikipedia.org/wiki/Sodium_valproate

 

From official FDA information at http://www.drugs.com/ppa/valproic-acid-and-derivatives-sodium-valproate-divalproex-sodium.html , this drug comes in these forms:

 

Divalproex Sodium

Depakote DR (delayed-release)

- Tablets, delayed-release 125 mg

- Tablets, delayed-release 250 mg

- Tablets, delayed-release 500 mg

 

From AbbVie:

Quote

Depakote tablets are “delayed-release,” which means they have a special coating that prevents the drug from dissolving too early in the digestive tract. Available in three strengths, Depakote must be taken twice a day....

 

Depakote ER (extended-release)

- Tablets, ER 250 mg

- Tablets, ER 500 mg

 

From AbbVie:

Quote

Depakote ER contains the same active ingredient as Depakote, (divalproex sodium) but it is designed to slowly deliver the medication over a 24-hour period. This means that Depakote ER only has to be taken once a day.

 

Extended-release divalproex in bipolar and other psychiatric disorders: A comprehensive review

 

https://www.ncbi.nlm.nih.gov/pubmed/16569797

Quote

VPA absorption from enteric-coated divalproex-DR is rapid following a lag-time of approximately 2 hours and is complete within 6-7 hours of dosing. In contrast, VPA absorption from divalproex-ER starts immediately after administration, but occurs at a slow, approximately constant rate over more than 20 hours.

 

 

Depakote Sprinkles

- Capsules, sprinkle 125 mg

 

From AbbVie:

Quote

Depakote Sprinkle Capsules work in the same way as Depakote delayed-release tablets [twice-a-day dosing]...the capsules can be swallowed whole or opened and the contents sprinkled on soft food.

 

from FDA information at https://www.drugs.com/pro/depakote-capsules.html#s-34069-5

Quote

 

Depakote Sprinkle Capsules may be swallowed whole or may be administered by carefully opening the capsule and sprinkling the entire contents on a small amount (teaspoonful) of soft food such as applesauce or pudding. The drug/food mixture should be swallowed immediately (avoid chewing) and not stored for future use. Each capsule is oversized to allow ease of opening.

....

Depakote Sprinkle Capsules are for oral administration. Depakote Sprinkle Capsules contain specially coated particles of divalproex sodium equivalent to 125 mg of valproic acid in a hard gelatin capsule.

 

 

Sodium Valproate

Depacon

- Injection 100 mg/mL

 

Depakene

- Capsules 250 mg (as valproic acid)

- Syrup 250 mg per 5 mL

 

Stavzor

- Capsules, delayed-release 125 mg (as valproic acid)

- Capsules, delayed-release 250 mg (as valproic acid)

- Capsules, delayed-release 500 mg (as valproic acid)

 

Dosage conversion from one form to another

 

http://www.drugs.com/ppa/valproic-acid-and-derivatives-sodium-valproate-divalproex-sodium.html

Quote

Conversion from Depakote to Depakote ER

Adults and children 10 yr of age and older

 

Patients with epilepsy previously receiving Depakote should be administered Depakote ER daily using a dose that is 8% to 20% higher than the daily dose of Depakote . For patients whose Depakote total daily dose cannot be directly converted to Depakote ER , consider, at the clinician's discretion, an increase in the patient's Depakote total daily dose to the next higher dosage before converting to the appropriate total daily dose of Depakote ER.

Additional conversion information for Depakote and Depakote ER (middle of page, under valproic acid): http://www.globalrph.com/anticonvulsants.htm

 

Depakine, Depakine Chrono, Epilim, Epilim Chrono

 

From Wikipedia http://en.wikipedia.org/wiki/Sodium_valproate)

Quote

In much of Europe, Depakine and Depakine Chrono (tablets) are equivalent to Epilim and Epilim Chrono

 

From Royal College of Psychiatrists http://pb.rcpsych.org/content/27/12/446/T1.expansion from The Psychiatrist December 1, 2003 vol. 27 no. 12 446-448

03_Fisher_valproate_table1.png

 

http://www.drugs.com/uk/epilim-chrono-spc-3544.html

Quote

Although there is no specific evidence of sudden recurrence of underlying symptoms following withdrawal of valproate, discontinuation should normally only be done under the supervision of a specialist in a gradual manner. This is due to the possibility of sudden alterations in plasma concentrations giving rise to a recurrence of symptoms. NICE has advised that generic switching of valproate preparations is not normally recommended due to the clinical implications of possible variations in plasma concentrations.

....The Epilim Chrono formulations are bioequivalent to Epilim Liquid and enteric coated (EC) formulations with respect to the mean areas under the plasma concentration time curves. Steady-state pharmacokinetic data indicate that the peak concentration (Cmax) and trough concentration (Cmin) of Epilim Chrono lie within the effective therapeutic range of plasma levels found in pharmacokinetic studies with Epilim EC.

 

http://www.drugs.com/uk/epilim-liquid-spc-9823.html

Quote

Epilim Liquid/Sodium Valproate 200mg/5ml Liquid

 

....Epilim Liquid may be given twice daily. Epilim Liquid should not be diluted.

 

In patients where adequate control has been achieved Epilim Chrono formulations are interchangeable with other Epilim conventional or prolonged release formulations on an equivalent daily dosage basis.

 

http://www.drugs.com/uk/epilim-100mg-crushable-tablets-spc-9824.html

Quote

Epilim 100mg Crushable Tablets

 

.... Epilim tablets may be given twice daily. Uncoated tablets may be crushed if necessary.

 

In patients where adequate control has been achieved Epilim Chrono formulations are interchangeable with other Epilim conventional or prolonged release formulations on an equivalent daily dosage basis.

 

http://www.mims.com/Thailand/drug/info/Depakine/Depakine-Depakine%20Chrono?type=full

Quote

Dilutions: If it is necessary to dilute Depakine oral solution, the recommended diluent is Syrup BP, but syrup containing sulfur dioxide (SO2) as a preservative should not be used. The diluted product will have a 14-day shelf-life.

 

Depakine tablets are hygroscopic and must be kept in their protective bottle until taken; they should be stored in a dry place. Depakine oral solution should be kept cool and away from direct sunlight.

 

Sanofi Epilim product insert www.sanofi.co.uk/products/Epilim_SPC.pdf

 

METHODS OF TAPERING

As there are many forms of sodium valproate, methods of tapering are described below in general terms. Tapering your drug will be highly individual. If you wish peer counseling for your taper, please start a topic for yourself in the Introductions forum.

 

Tapering from an injection

There is no way to taper from an injection, you need to let the effects wear off. Consult your physician to find out when you can expect this.

 

If you get withdrawal symptoms towards the end of the injection period or after an injection wears off, you may wish to take a very low dose, such as 5mg, of a liquid form or something like Depakote Sprinkles for a month to allow your nervous system to accommodate, then slowly taper off by miniscule amounts over some months. See Why taper by 10% of my dosage?

 

Taper using a liquid

If you are taking tablets or capsules, initially converting part of your dose to a liquid (taking the other part in tablet or capsule form) and tapering the liquid portion is the easiest way to gradually lower your dosage.

 

Using an oral syringe and other tapering techniques

 

Your drug may come in a liquid form by prescription. Or, you may wish to get a liquid compounded (see Compounding pharmacies (US, UK, and elsewhere)),

 

Many immediate-release drugs can be made into a liquid with water, see  How to make a liquid from tablets or capsules Drugs that are extended-release or delayed-release cannot be made into a liquid.

 

Cutting up tablets to taper

If your drug is not "extended release," "delayed release," or otherwise coated in a way that it cannot be split, you may be able to split tablets to taper, see Which tablets or pills may be split or crushed?

 

However, this leads to inexact dosages that may cause problems when you're take a low dose. See How to cut up tablets or pills

 

To be more accurate in your dosing, you may wish to weigh tablet fragments, see Using a digital scale to measure doses , or switch part of your dose to a liquid.

 

Taper using a combination of tablets or Depakote Sprinkles capsules

Drugs come in a range of tablets or capsule strengths -- unfortunately, what's available by prescription is usually not adequate for gradual tapering.

 

One might combine tablets, capsules, and parts of tablets and capsules to provide those interim dosages. We have several people successfully tapering Depakote by using Depakote Sprinkles capsules.

 

You do not have to put Depakote Sprinkles in food, you can weigh the particles for your custom dose (see Using a digital scale to measure doses) and put them in another gelatin capsule to swallow. Close the original capsule and reserve the rest of the Sprinkles for your next dose. Store the capsules properly, the drug will be destroyed by moisture.

 

For example:

 

If you are taking 500mg Depakote ER, a reduction of 10% would give you a dosage of 450mg. You can combine a 125mg tablet, a 250mg tablet -- 375mg in tablets -- and half of a 125mg Depakote Sprinkles capsule or 62.5mg for a total daily dose of 437.5mg Depakote.

 

This is a greater reduction than to 450mg, but it's less steep than other tablet combinations. If you wish to make a more exact 450mg dose, Using a digital scale to measure doses, you would weigh out enough Sprinkles for 75mg to add to your 375mg in tablets for a total daily dose of 450mg.

 

Your next reduction of 10% would be to 405mg; you would weigh out 30mg in Sprinkles to augment the 375mg in tablets. And so forth, using the Sprinkles to compose your doses with the Depakote ER tablets.

 

Have a compounding pharmacy make up Depakote Sprinkles capsules of smaller dosages
A compounding pharmacy can accurately weigh small doses and put them into capsules for you. Depakote Sprinkles should be taken twice a day. Insurance coverage varies, this is usually somewhat expensive. See see Compounding pharmacies (US, UK, and elsewhere)

 

Edited by Altostrata
updated

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Altostrata
On 6/21/2016 at 4:48 PM, Zant808 said:

Thanks again for replying. I finally managed to reach my pdoc and he said try to come visit him tomorrow. I said I would not be able to visit him tomorrow given my circumstances. He does not want me to go to the ER because he fears they will give me an antipsychotic. He wants me to reinstate a low dose of Depakote Sprinkles although he admittedly does not know what amount I should be reinstating at. I tried resting in my chair only to now find that my symptoms have switched to mild myoclonic jerks and mild brain zaps. While not nearly as severe as when discontinuing other medications, the fear from them and the realization of failing my final chance at a taper was so intense that cried for at least 30 minutes straight. I have not cried that much probably since before being medicated at all. I don't know if the crying is a sign of healing or withdrawal or progression of iatrogenes or progression of mental illness. I will however reinstate the 5 mg of Depakote Sprinkles as a test. As the outcome of this is very unpredictable, I will leave this information in case this is my final post for a long time due to possible forced hospitalization. Perhaps it can help someone who is on Depakote and suffering from it to come off safely.

 

Reducing Dr. Reddy's brand of Depakote Sprinkles

Scale's bowl is approximately 2.705 grams

Remember to tare to 0 to account for the bowl's weight

125 mg Depakote Sprinkles contents inside weighs .250 grams

 

.5 mg Depakote = .001 grams

1 mg Depakote = .002 grams

1.25 mg Depakote = .0025 grams

2.5 mg Depakote = .005 grams

5 mg Depakote = .01 grams

10 mg Depakote = .02 grams

12.5 mg Depakote = .025 grams

25 mg Depakote = .0500 grams

50 mg Depakote = .1 grams

62.5 mg Depakote = .125 grams

75 mg Depakote = .15 grams

100 mg Depakote = .2 grams

125 mg Depakote = .250 grams

....

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MM731

Would it be possible to make a liquid suspension with Depakote ER (Divalproex Sodium) tablets?

I was planning on putting a 250mg tablet in 250ml of distilled water and taking out 20ml (20mgs) but I haven't been able to find anyone who has done it this way. 

Will the potency of the Extended Release tablets be altered when I make a liquid solution? Should I dose more than once a day?

Also, after reading some posts I see that some say it's okay to put liquid suspensions in the fridge and others say it isn't necessary. 

Any information is greatly appreciated, thank you!

 

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Altostrata

No, you cannot make a liquid from extended-release tablets. Usually, these tablets are formulated with a binder or glue that will make your liquid lumpy, at best. Depakote Sprinkles capsules are very handy for tapering, see post #1.

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MM731

I ended up making a liquid last night, no lumps just very cloudy. I've read post #1 but my doctor will not prescribe Depakote Sprinkles. He doesn't believe I'm having withdrawal effects at this low a dosage and wants me to just stop the Depakote.  

 

  8d6Ty0m.jpg

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