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valproic acid PO

valproic acid PO
Drug Name Form Strength Non-Formulary Restricted TX Sub Notes
Divalproex Sodium      
Depakene CAPSULE, ORAL 250 mg      
Depakote Sprinkles DELAYED RELEASE CAPSULE, ORAL 125 mg      
Depakote DELAYED RELEASE TABLET, ORAL 125 mg; 250 mg      
Depakene SYRUP, ORAL 250 mg/5 mL      
Depakote ER TABLET, EXTENDED RELEASE, ORAL 250 mg; 500 mg      
Display Anticonvulsants, Miscellaneous, Antimanic Agents, Antimigraine Agents, Miscellaneous Class: 281292, 282800, 283292
Medication comments:
USP <800> Hazardous Drug Assessment of Risk (AOR)
Per policy, these drugs are exempt from USP <800> handling requirements under normal circumstances.
The following outlines must be followed.
generic (Brand) Route
[Packaging: Manufacturer ⇒ Dispense]		 Activities
valproic acid (Depakene, Depakote) PO
[UD ⇒ UD]		  125 mg EC tablet (IDBH)
250 mg ER tablet (IDBH)
250 mg EC tablet (IDBH)
500 mg ER tablet
250 mg capsule
125 mg sprinkle
250 mg/5 mL cup		 Stock @ IDBH? Y
NIOSH Table 2B↑
Pharmacy:
Receiving / Storage / Preparation

Exposure Risk: minimal
 • Handling/preparation PPE Requirements: n/a
• Receiving from Distributor: Standard
• Pharmacy Storage Area: Carousel
• Packaging/Reconstitution Location: n/a
• Compounding (Non-Sterile/Sterile) Location: n/a
• Omnicell Load: Yes
Transport • Transport (dose is placed inside a plastic sealable bag): Standard
Nursing:
Storage / Administration

Exposure Risk: low
 • Handling/administration PPE Requirements: via Mouth- Single pair of CX approved gloves
via Tube- double CX gloves and gown
Wash hands after handling
• Storage of Finished dose in Nursing Area/Procedural Area: Omnicell
• Signage on Patient Door Required: No
• Manipulation of Dosage Form: Standard
• Special Manipulation for Administration: n/a
Disposal / Spills • Disposal of Drug Waste: Full-  blue bin 
Trace/packaging- trash
• Disposol of Used PPE: trash bin (inside plastic bag)
• Spill management: n/a
NIOSH Supplemental Information: BBW for teratogenicity; congenital malformations, including neural tube defects; teratogenic in muliple species
Reason for exemption of USP<800> Containment Requirements: Purchased in final dosage form; packaged as unit dose. Does not require additional manipulation for dispensing.
Enteral Drug Administration notes.
Generic
(Brand)		 Comments and Considerations Recommendations for Administration with Enteral Nutrition
valproic acid
(Depacon, Depakote)		 Administration with food may delay rate of absorption Suggest administering same total daily dose, but use valproic acid solution dosed every 6-8 hours. Monitor levels.
2023 American Geriatrics Society Beers Criteria® for potentially inappropriate medication use in older adults.
Medication: valproic acid (Depacon, Stavzor)
Criteria 2: Potentially inappropriate medication use in older adults due to drug–disease or drug–syndrome interactions that may exacerbate the disease or syndrome. (Table 3)
Drug(s) ⇆ disease or syndrome antiepileptics ⇄ History of falls or fractures
Rationale May cause ataxia, impaired psychomotor function, syncope, or additional falls. If one of the drugs must be used, consider reducing the use of other CNS-active medications that increase the risk of falls and fractures. (i.e., anticholinergics, selected antidepressants, antiepileptics, antipsychotics, sedative/hypnotics including benzodiazepines and, Nonbenzodiazepine benzodiazepine receptor agonist hypnotics, opioids) and implement other strategies to reduce fall risk.
Recommendation Avoid except for seizures and mood disorders.
 Quality of evidence: High, Strength of Recommendation: Strong
 
Criteria 4: Potentially clinically important drug-drug interactions that should be avoided in older adults. (Table 5)
Interacting drug(s) or class(es) antiepileptics (including gabapentinoids) ⇄ CNS-active agents
Risk Rationale Increased risk of falls and of fracture with the concurrent use of ≥3 CNS-active agents (antiepileptics including gabapentinoids, antidepressants, antipsychotics, benzodiazepines, Nonbenzodiazepine benzodiazepine receptor agonist hypnotics, opioids, and skeletal muscle relaxants).
Recommendation Avoid concurrent use of ≥3 CNS-active drugs Click for list; minimize the number of CNS-active drugs.
 Quality of evidence: High, Strength of Recommendation: Strong
Pediatric Pharmacy Association 2025 KIDs List of Key Potentially Inappropriate Drugs in Pediatrics 
Medication: divalproex (Depakote)
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug valproic acid and derivatives
Risk/Rationale Pancreatitis, fatal hepatotoxicity
Recommendation Avoid in younger than 2 yr
Caution in 2-6 yr
 Quality of evidence: High, Strength of Recommendation: Strong
Last updated: Sep. 25, 2025
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Pharmacy Contact Info:

Main Inpatient Pharmacy: ext 4599, 3503
Fax: 704-878-7283

Director of Pharmacy - Randi Raynor, PharmD: ext 4501
Clinical Coordinator - Laura Rollings, PharmD: ext 4597
Pharmacy Informaticist - Stephen Pringle, PharmD: ext 7645
Pharmacy Technician Supervisor - Amy Wingler, CPhT: ext 7385
Pharmacy Automation Coordinator (Omnicell) - Melissa Fulford, CPhT: ext 3556



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