From the Guidelines
Depacon, or valproate sodium, is a highly effective treatment for seizure disorders, particularly status epilepticus, with a recommended loading dose of 15-20 mg/kg given intravenously, followed by maintenance doses of 10-15 mg/kg/day divided into multiple infusions, as supported by the most recent and highest quality study 1.
Key Considerations
- Depacon works by increasing levels of gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter in the brain that helps reduce excessive neuronal activity.
- Common side effects include dizziness, drowsiness, nausea, and vomiting.
- Patients should be monitored for liver function abnormalities, platelet counts, and ammonia levels during treatment.
- Depacon requires careful dosing in patients with liver disease and is contraindicated in patients with urea cycle disorders or mitochondrial disorders.
- It should be used with extreme caution in pregnant women due to risk of birth defects.
Clinical Guidelines
- The Neurocritical Care Society’s Status Epilepticus Guideline Writing Committee recommended urgent control of seizures with valproate, among other options, based on high-level evidence 1.
- The European Federation of Neurological Societies’ evidence-based guideline for status epilepticus in adults also supports the use of valproate for refractory status epilepticus.
Monitoring and Maintenance
- Blood levels should be monitored to maintain therapeutic concentrations between 50-100 μg/mL for most indications.
- When transitioning from IV to oral valproic acid formulations, the same daily dose can typically be used.
Important Notes
- The most recent studies, such as those published in 2025 2, 3, focus on the prevention of episodic migraine headache using pharmacologic treatments, but do not provide new evidence on the use of Depacon for seizure disorders.
- Therefore, the recommendation for Depacon use is based on the highest quality study available, which is the 2014 study published in the Annals of Emergency Medicine 1.
From the FDA Drug Label
Valproic acid is administered orally. Valproic acid is indicated as monotherapy and adjunctive therapy in complex partial seizures in adults and pediatric patients down to the age of 10 years, and in simple and complex absence seizures. The FDA drug label does not answer the question about Depacon.
From the Research
Depacon Overview
- Depacon, also known as valproate sodium, is a medication used to treat various conditions, including epilepsy, migraine, and mental illness 4, 5, 6, 7, 8
- It is available in different forms, including intravenous, oral, and combination therapies 5, 6, 8
Efficacy in Migraine Treatment
- Valproate sodium has been shown to be effective in reducing headache frequency and improving migraine-related quality of life in adult patients with episodic migraine 6
- Intravenous valproate sodium may be of assistance in the initial management of patients with chronic daily headache/transformed migraine and analgesic/triptan overuse 5
- A study found that 80% of patients treated with intravenous valproate sodium reported improvement in headache, and the medication was tolerated well by most patients 5
Safety and Adverse Effects
- Valproate sodium can cause serious side effects, including hyperammonemia, L-carnitine deficiency, and urea cycle enzyme dysfunction 7
- Delayed identification of valproic acid-induced encephalopathy could be potentially fatal, highlighting the importance of prompt diagnosis and treatment 7
- The medication should not be given to women of childbearing potential for migraine prevention due to the risk of adverse outcomes for infants of exposed mothers 4