Before you begin using a medication, be sure to inform your doctor of any medical conditions or Allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use Epival (Divalproex).
Behaviour changes: People taking Epival (Divalproex) have occasionally experienced aggressive behaviour or hostility, anxiousness, disorientation, or decreased memory. If you experience any of these effects or notice them in a family member who is taking Epival (Divalproex), contact your doctor as soon as possible.
Blood clotting: Epival (Divalproex) may make it more difficult for the blood to clot. If you take anticoagulant medications (blood thinning) medications, discuss with your doctor how Epival (Divalproex) may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Epival (Divalproex), and whether any special monitoring is needed. If you notice any signs of bleeding, such as frequent nosebleeds, unexplained bruising, or black and tarry stools, notify your doctor as soon as possible. Your doctor will order routine blood tests to make sure potential problems are caught early.
Drowsiness/reduced alertness: Epival (Divalproex) may cause drowsiness, especially when combined with alcohol or another sedating medication. Avoid driving or other potentially dangerous activities until you determine how Epival (Divalproex) affects you.
Hypersensitivity reaction: A Anaphylaxis (severe allergic reaction) called hypersensitivity reaction has occurred on rare occasions for some people with the use of Epival (Divalproex), as well as other medications to treat seizures. This reaction involves a number of organs in the body and may be fatal if not treated quickly. Stop taking the medication and get immediate medical attention if you have symptoms of a severe allergic reaction, including fever, swollen glands, yellowing of the skin or eyes, or flu-like symptoms with skin rash or blistering.
Kidney Disease: Kidney disease or reduced kidney function may cause Epival (Divalproex) to build up in the body, causing side effects. If you have reduced kidney function or kidney disease, discuss with your doctor how Epival (Divalproex) may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Epival (Divalproex), and whether any special monitoring is needed.
Liver function: Liver failure has occurred infrequently for people taking Epival (Divalproex). In most cases, this has happened during the first 6 months of treatment. The risk is highest for children under the age of 2 years, especially those who take more than one antiseizure medication, or those who have certain medical conditions (e.g., metabolic disorders, brain disease, severe seizure disorders accompanied by mental retardation). Children aged 3 to 10 years are also at a higher risk if they take more than one antiseizure medication. Liver function tests should take place before starting treatment with Epival (Divalproex). Your doctor may also perform liver function tests regularly to monitor the function of your liver. Serious liver problems may happen after symptoms such as loss of seizure control, malaise, weakness, lethargy, loss of appetite, and vomiting. People who take valproic acid should tell their doctor at once if they experience these symptoms. Increases in the levels of ammonia in the blood, with or without lethargy or coma, have been reported and may be present despite normal liver function tests.
Pancreatitis: People taking Epival (Divalproex) have experienced life-threatening pancreatitis (inflammation of the pancreas). These cases have occurred shortly after starting the medication and after several years of taking the medication. If you experience signs of pancreatitis such as abdominal pain on the upper left side, back pain, loss of appetite, nausea, fever, chills, rapid heartbeat, or swollen abdomen, contact your doctor immediately.
Suicidal thoughts: There is a small risk that Epival (Divalproex) may result in thoughts of suicide. If you experience these symptoms or any other behaviour change while taking Epival (Divalproex), contact your doctor immediately. Family members or caregivers of people who are taking Epival (Divalproex) should contact the person's doctor immediately if they notice unusual behaviour changes.
Stopping Epival (Divalproex): People who need Epival (Divalproex) to prevent major seizures should not stop taking it suddenly as this can increase the risk of getting seizures. Do not stop taking Epival (Divalproex) without consulting with your doctor first.
Pregnancy: There is an increased risk of serious birth defects for a child whose mother takes Epival (Divalproex) during pregnancy. Epival (Divalproex) may cause a number of defects including a defect of the spine called Spina Bifida, cleft palate, heart defects, Autism, or slowed or reduced mental development. Epival (Divalproex) should not be used during pregnancy for treatment of epilepsy unless there is no other suitable alternative treatment. Epival (Divalproex) should not be used during pregnancy for treatment of bipolar disorder. Women of child-bearing age must use effective contraception while taking Epival (Divalproex).
Before becoming pregnant, women who are taking Epival (Divalproex) should speak to their doctor. If possible, a switch to another medication to treat epilepsy should be considered. If you become pregnant while taking Epival (Divalproex), contact your doctor immediately.
Breast-feeding: Epival (Divalproex) passes into breast milk. If you are a breast-feeding mother and are taking Epival (Divalproex), it may affect your baby. Talk to your doctor about whether you should continue breast-feeding. As a general rule, women who are taking Epival (Divalproex) should not breast-feed.
Children: If Epival (Divalproex) is taken by children 2 years old or younger, it should not be used in combination with other antiseizure medications and the doctor should monitor the child regularly. Epival (Divalproex) is not recommended for treatment of mania in children under 18 years of age.
Seniors: People over the age of 65 may be more at risk of developing side effects from Epival (Divalproex) and may require lower dosages.
