Over dosage with valproate may result in somnolence, heart block, and deep coma. Fatalities have been reported; however patients have recovered from valproate levels as high as 2120 mcg/mL.

In overdose situations, the fraction of drug not bound to protein is high and hemodialysis or tandem hemodialysis plus hemoperfusion may result in significant removal of drug. The benefit of gastric lavage or emesis will vary with the time since ingestion. General supportive measures should be applied with particular attention to the maintenance of adequate urinary output.

Naloxone has been reported to reverse the CNS depressant effects of valproate over dosage. Because naloxone could theoretically also reverse the antiepileptic effects of valproate, it should be used with caution in patients with epilepsy.

• Depakote ER (divalproex sodium) should not be administered to patients with hepatic disease or significant hepatic dysfunction [see WARNINGS AND PRECAUTIONS].
• Depakote ER (divalproex sodium) is contraindicated in patients with known hypersensitivity to the drug [see WARNINGS AND PRECAUTIONS].
• Depakote ER (divalproex sodium) is contraindicated in patients with known urea cycle disorders [see WARNINGS AND PRECAUTIONS].

Last reviewed on RxList: 11/2/2009
This monograph has been modified to include the generic and brand name in many instances.