Can Divalproex (valproate) capsules be opened and sprinkled on food, such as applesauce, for patients who have difficulty swallowing?

Divalproex Can Be Opened and Sprinkled on Applesauce

Yes, divalproex capsules can be opened and the contents sprinkled on applesauce for patients who have difficulty swallowing. According to the FDA drug label, although the rate of valproate ion absorption may vary with different administration methods (including sprinkling on food), these differences are of minor clinical importance under steady state conditions achieved in chronic treatment 1.

Administration Options for Patients with Swallowing Difficulties

• The FDA drug label specifically mentions that divalproex sodium sprinkle capsules can be administered by sprinkling the contents on soft food such as applesauce 1
• This administration method is particularly useful for patients who have difficulty swallowing intact capsules, which is a common problem especially in elderly patients 2
• When sprinkled on applesauce, the medication maintains its bioavailability, although there may be slight changes in the absorption rate (Tmax) compared to taking the intact capsule 1

Important Considerations When Sprinkling Medication

• The entire contents of the capsule should be sprinkled on a small amount of applesauce to ensure the full dose is administered 1
• The mixture should be swallowed immediately without chewing to maintain the integrity of the medication 1, 3
• The medication should not be crushed or chewed as this could potentially alter the drug's release properties 3
• Applesauce is specifically mentioned as an appropriate vehicle for medication administration in clinical guidelines 4

Clinical Evidence Supporting This Practice

• Studies with other enteric-coated medications have shown that mixing with applesauce does not negatively affect the enteric coating, maintaining drug stability and proper release characteristics 2
• Research indicates that applesauce is an acceptable vehicle for administration of medications that can be opened or sprinkled, as it maintains the integrity of the medication formulation 2, 5
• In a study with another medication (duloxetine), pellets mixed with applesauce remained stable at room temperature for up to 2 hours and allowed for full dose delivery 2

Cautions and Contraindications

• The mixture should be consumed immediately after preparation to ensure stability 2
• This administration method should only be used for formulations specifically approved for sprinkling, such as divalproex sprinkle capsules 1, 3
• For patients with dysphagia, a formal swallowing evaluation may be needed to ensure this method is appropriate and safe 4
• Some medications should never be crushed or opened due to potential changes in drug release patterns or stability, but divalproex sprinkle capsules are specifically designed to allow for this administration method 1, 3

Alternative Approaches for Patients with Swallowing Difficulties

• For patients with more severe dysphagia, texture-adapted foods may be considered beyond just applesauce 4
• If swallowing remains unsafe despite texture modification, alternative routes of administration may need to be considered 4
• Postural maneuvers (such as chin-tuck posture) can sometimes help patients with moderate dysphagia safely swallow medications mixed with food 4

Remember that while divalproex can be sprinkled on applesauce, this should only be done with formulations specifically designed for this purpose, such as the sprinkle capsules mentioned in the FDA drug label 1.