Skip to content
My WebMD Sign In, Sign Up

Depakote ER oral

Valproic Acid Derivatives/Topiramate

This information is generalized and not intended as specific medical advice. Consult your healthcare professional before taking or discontinuing any drug or commencing any course of treatment.

Medical warning:

Moderate. These medicines may cause some risk when taken together. Contact your healthcare professional (e.g. doctor or pharmacist) for more information.

How the interaction occurs:

How this interaction occurs is not exactly known.

What might happen:

Using these medicines together may increase the risk of a severe (sometimes fatal) brain disorder (encephalopathy) caused by high levels of ammonia in the blood.

What you should do about this interaction:

This interaction may be more likely if you have certain metabolic disorders, such as a urea cycle disorder. Let your healthcare professionals (e.g. doctor or pharmacist) know if you or someone in your family has a urea cycle disorder. Also let your healthcare professional know if you have ever: had encephalopathy or been in a coma; had elevated ammonia or glutamine levels; had cycles of vomiting and weakness, had episodes of extreme irritability, loss of muscle control; been told to avoid protein, or have a family history of unexplained infant deaths. These can be signs of a urea cycle disorder.While taking these medicines, let your doctor know right away if you develop any unexplained weakness, vomiting, sudden mental changes, or a decrease in body temperature. Your doctor may want to check the amount of ammonia in your blood.Your healthcare professionals may already be aware of this interaction and may be monitoring you for it. Do not start, stop, or change the dosage of any medicine before checking with them first.

References:

1.Depakote (divalproex sodium) US prescribing information. AbbVie Inc. June, 2013.
2.Depacon (valproate sodium) US prescribing information. Abbott Laboratories July 12, 2006.
3.Depakene (valproic acid) US prescribing information. Abbott Laboratories January, 2009.
4.Topamax (topiramate) US prescribing information. Janssen Pharmaceuticals, Inc. October, 2012.
5.Hamer HM, Knake S, Schomburg U, Rosenow F. Valproate-induced hyperammonemic encephalopathy in the presence of topiramate. Neurology 2000 Jan 11;54(1):230-2.
6.Longin E, Teich M, Koelfen W, Konig S. Topiramate enhances the risk of valproate-associated side effects in three children. Epilepsia 2002 Apr; 43(4):451-4.
7.Ortiz-Saenz de Santa Maria MR, Barriuso-Perez E, Soto-Alvarez MI, Moche-Loeri JA. Ring chromosome 20, hypersensitivity to valproate and hyperammonemic encephalopathy. Rev Neurol 2003 Oct 16-31;37(8):733-5.
8.Cheung E, Wong V, Fung CW. Topiramate-valproate-induced hyperammonemic encephalopathy syndrome: case report. J Child Neurol 2005 Feb; 20(2):157-60.
9.Panda S, Radhakrishnan K. Two cases of valproate-induced hyperammonemic encephalopathy without hepatic failure. J Assoc Physicians India 2004 Sep; 52:746-8.
10.Rath A, Naryanan TJ, Chowdhary GV, Murthy JM. Valproate-induced hyperammonemic encephalopathy with normal liver function. Neurol India 2005 Jun;53(2):226-8.
11.Latour P, Biraben A, Polard E, Bentue-Ferrer D, Beauplet A, Tribut O, Allain H. Drug induced encephalopathy in six epileptic patients: topiramate? valproate? or both?. Hum Psychopharmacol 2004 Apr; 19(3):193-203.
12.Solomon GE. Valproate-induced hyperammonemic encephalopathy in the presence of topiramate. Neurology 2000 Aug 22;55(4):606.
13.Rosenfeld WE, Liao S, Kramer LD, Anderson G, Palmer M, Levy RH, Nayak RK. Comparison of the steady-state pharmacokinetics of topiramate and valproate in patients with epilepsy during monotherapy and concomitant therapy. Epilepsia 1997 Mar;38(3):324-33.
14.Mimrod D, Specchio LM, Britzi M, Perucca E, Specchio N, La Neve A, Soback S, Levy RH, Gatti G, Doose DR, Maryanoff BE, Bialer M. A comparative study of the effect of carbamazepine and valproic acid on the pharmacokinetics and metabolic profile of topiramate at steady state in patients with epilepsy. Epilepsia 2005 Jul;46(7):1046-54.

See 244 Reviews for this Drug. - OR -

Review this Treatment

Find a Drug:

by name or medical condition or shape/color (Pill Identifier)

(for example: aspirin)

(for example: diabetes)

Report Problems to the Food and Drug Administration
 
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.

Health Solutions From Our Sponsors

Ask the pharmacist

Questions about medications? Get expert answers by video or live chat about allergies, pregnancy, sleep, and more.
See the Ask the Pharmacist event schedule.

Ask a Question

Popular Slideshows & Tools on WebMD

tea
What you should eat.
Woman sitting in front of UV lights
Is yours working?
woman using breath spray
What's causing yours?
colon xray
Get the facts.
MS Overview
Recognizing symptoms.
bowl of yogurt with heart shape
Eat for a healthy heart.
woman doing pushups
To help you get fit.
Colored x-ray of tooth decay
Know what to look for.
Woman sitting with child
Do you know the symptoms?
fruit drinks
Foods that can help you focus.
Sad dog and guacamole
Don't feed this to your dog.
Thyroid exam
See how much you know.

Women's Health Newsletter

Find out what women really need.

WebMD the app

Get trusted health information. Whenever. Wherever... with your iPhone, iPad or Android.

Find Out More

IMPORTANT: About This Section and Other User-Generated Content on WebMD

The opinions expressed in WebMD User-generated content areas like communities, reviews, ratings, or blogs are solely those of the User, who may or may not have medical or scientific training. These opinions do not represent the opinions of WebMD. User-generated content areas are not reviewed by a WebMD physician or any member of the WebMD editorial staff for accuracy, balance, objectivity, or any other reason except for compliance with our Terms and Conditions. Some of these opinions may contain information about treatment or uses of drug products that have not been approved by the U.S. Food and Drug Administration. WebMD does not endorse any specific product, service, or treatment.

Do not consider WebMD User-generated content as medical advice. Never delay or disregard seeking professional medical advice from your doctor or other qualified healthcare provider because of something you have read on WebMD. You should always speak with your doctor before you start, stop, or change any prescribed part of your care plan or treatment. WebMD understands that reading individual, real-life experiences can be a helpful resource but it is never a substitute for professional medical advice, diagnosis, or treatment from a qualified health care provider. If you think you may have a medical emergency, call your doctor or dial 911 immediately.