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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by Collete on July 31, 2001, at 21:11:28
I was going to start my Depakote tonight by breaking a 250mg in 1/2 but found out that is a no-no. I am worried about starting at 250, since I also take Prozac 40mg in AM and 2 bendryls and .5mg Xanax at night. I know this is in the pdocs file, but I am still worried about all the interactions based on the information that came with my Rx. Can anyone reassure me that these medicines will no interact? Thank you, Collette
Posted by Sunnely on July 31, 2001, at 22:30:48
In reply to Question about starting Depakote, posted by Collete on July 31, 2001, at 21:11:28
If there are no contraindication(s), take Depakote as prescribed by your doctor (250 mg) at night. It may make you a bit drowsy since you are also taking Benadryl and Xanax. But this mix of meds should not pose a major concern. No major drug-drug interaction between Depakote and Prozac, either. Although Prozac is a potent inhibitor of cytochrome P450 enzyme, specifically CYP2D6, Depakote largely depends on a different pathway for its metabolism.
FYI, Depakote can be started with a loading dose based on 20 mg/kg/day (or roughly the weight in lbs x 10) in 2 or 3 divided doses, in manic patients. Which means an acutely manic person who weighs approximately 200 lbs may be started on 2000 mg of Depakote.
One thing you should know about Depakote, though. It has been associated with birth defects, in particular, spina bifida and other defects related to failure of the spinal canal to close normally. So, make sure you are not pregnant before starting Depakote. If you are not pregnant, you may want to consider taking supplemental folic acid 400 microgram once daily, while on Depakote. (At any rate, women of child-bearing age should take supplemental folic acid 400 mcg whether taking Depakote or not.) If you plan to get pregnant, discuss this issue with your doctor before taking Depakote. There is one study done that indicates that there seems to be a high incidence of polycystic ovaries (PCOs) in teen age epileptic women taking Depakote. I believe, this finding has been questioned by others, however.
Another thing you should know about Depakote. You should have normal liver enzymes before taking Depakote. Although uncommon in adults, Depakote can cause hepatotoxicity. This is more common in children, especially those who take Depakote along with another anticonvulsant drug. Rarely, Depakote has been reported to cause pancreatitis. In some patients with low levels of carnitine, taking Depakote (or valproic acid) may put them at risk for dangerously elevated levels of blood ammononia (hyperammonemia).
Another thing you should know about Depakote. It comes in Delayed Release (DR) and Extended Release (ER). Depakote DR can be taken more than once a day but Depakote ER should be taken only once a day. If Depakote ER is taken more than once a day, it may lead to Depakote toxicity. Depakote ER is released in the stomach, small intestine, and large intestine over an 18 to 24 hour period of time. This slow release lessens the side effects and makes it more tolerable. BTW, Depakote ER is only FDA-approved for migraine but that does not mean it cannot be prescribed for psychiatric conditions such as bipolar disorder or augmentation treatment of depression.
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> I was going to start my Depakote tonight by breaking a 250mg in 1/2 but found out that is a no-no. I am worried about starting at 250, since I also take Prozac 40mg in AM and 2 bendryls and .5mg Xanax at night. I know this is in the pdocs file, but I am still worried about all the interactions based on the information that came with my Rx. Can anyone reassure me that these medicines will no interact? Thank you, Collette
Posted by Collete on August 1, 2001, at 8:37:35
In reply to Re: Question about starting Depakote » Collete, posted by Sunnely on July 31, 2001, at 22:30:48
Thank you so much for all that information! Since I am 56 and sans uterus, I am safe on that front! I just wonder why the doc didn't start me on a lower dose. We are hoping for help with insomnia as well as augmenting my Prozac, so I think the nightly dose will make the most sense.
Posted by paxvox on August 3, 2001, at 19:57:28
In reply to Re: Question about starting Depakote, posted by Collete on August 1, 2001, at 8:37:35
> Thank you so much for all that information! Since I am 56 and sans uterus, I am safe on that front! I just wonder why the doc didn't start me on a lower dose. We are hoping for help with insomnia as well as augmenting my Prozac, so I think the nightly dose will make the most sense.
I really did not like the Depakote as a "sleep aid", thought many apparently seem to be OK with it. There are just too many possible side effects, albeit statistically small, to use this every night. If you read my posts, you will see I am a proponent of the benzos for sleep disturbances. If used within established parameters (i.e. you don't increase dose) they can , and have, been used safely for decades. They do have some possible concerns for women of child-bearing potential, but as you say, that is not a concern of yours. If the Depakote makes you feel sluggish or nauseated, don't take it. Tell your Pdoc you want something else.
This is the end of the thread.
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