From the FDA Drug Label
Antiepilepsy drugs should not be abruptly discontinued in patients in whom the drug is administered to prevent major seizures because of the strong possibility of precipitating status epilepticus with attendant hypoxia and threat to life
To carefully titrate off of 500 mg daily of Depakote, gradual reduction is necessary. The exact protocol for tapering is not specified in the label, but it is recommended to reduce concomitant antiepilepsy drug (AED) dosage by approximately 25% every 2 weeks.
- The speed and duration of withdrawal can be highly variable.
- Patients should be monitored closely during this period for increased seizure frequency. 1
From the Research
To safely titrate off 500 mg daily of Depakote (valproic acid/divalproex sodium), I recommend a gradual taper over 2-4 weeks under close medical supervision. This approach is based on the principle of minimizing the risk of withdrawal symptoms, such as anxiety, irritability, mood changes, or seizures, which can occur when discontinuing antiepileptic medications like Depakote 2.
Tapering Schedule
Begin by reducing your dose by 125 mg every 5-7 days, for example:
- Week 1: 500 mg to 375 mg daily
- Week 2: 375 mg to 250 mg daily
- Week 3: 250 mg to 125 mg daily
- Week 4: 125 mg daily before stopping completely
This schedule may need adjustment based on your individual response and medical history. It's crucial to monitor for withdrawal symptoms during the taper and keep a symptom diary to share with your healthcare provider.
Importance of Gradual Taper
Never stop Depakote abruptly, as this can trigger seizures or serious mood destabilization, even in patients taking it for conditions other than epilepsy 3. The gradual reduction allows your brain to adjust to decreasing levels of the medication, as Depakote works by affecting GABA neurotransmitters and sodium channels in the brain.
Medical Supervision
Close medical supervision is essential during the tapering process. If you experience concerning symptoms, contact your healthcare provider immediately, as your taper schedule may need modification. The goal is to balance the need to discontinue the medication with the risk of withdrawal symptoms, ensuring the best possible outcome in terms of morbidity, mortality, and quality of life 4.