SPL MEDGUIDE

MEDICATION GUIDE

Divalproex Sodium (dye val' proe ex soe' dee um) Delayed-Release Capsules, USP

for oral use

What is the most important information I should know about divalproex sodium delayed-release capsules?

Do not stop divalproex sodium delayed-release capsules without first talking to a healthcare provider. Stopping divalproex sodium delayed-release capsules suddenly can cause serious problems. Stopping a seizure medicine suddenly in a patient who has epilepsy can cause seizures that will not stop (status epilepticus). 

Divalproex sodium delayed-release capsules can cause serious side effects, including: 

1. Serious liver damage that can cause death, especially in children younger than 2 years old and patients with mitochondrial disorders. The risk of getting this serious liver damage is more likely to happen within the first 6 months of treatment.

Call your healthcare provider right away if you get any of the following symptoms:

• feeling very weak, tired, or uncomfortable (malaise)
• swelling of your face
• not feeling hungry
• nausea or vomiting that does not go away
• diarrhea
• pain on the right side of your stomach (abdomen)
• dark urine
• yellowing of your skin or the whites of your eyes
• loss of seizure control in people with epilepsy

In some cases, liver damage may continue even though the medicine is stopped. Your healthcare provider will do blood tests to check your liver before and during treatment with divalproex sodium delayed-release capsules.

2. Divalproex sodium delayed-release capsules may harm your unborn baby.

• If you take divalproex sodium delayed-release capsules during pregnancy for any medical condition, your baby is at risk for serious birth defects that affect the brain and spinal cord (such as spina bifida or neural tube defects). These defects can begin in the first month, even before you know you are pregnant. Other birth defects that affect the structures of the heart, head, arms, legs, and the opening where the urine comes out (urethra) on the bottom of the penis can also happen. Decreased hearing or hearing loss can also happen.
• Birth defects may occur even in children born to women who are not taking any medicines and do not have other risk factors.
• Taking folic acid supplements before getting pregnant and during early pregnancy can lower the chance of having a baby with a neural tube defect.
• If you take divalproex sodium delayed-release capsules during pregnancy for any medical condition, your child is at risk for having lower IQ and may be at risk for developing autism or attention deficit/hyperactivity disorder.
• There may be other medicines to treat your condition that have a lower chance of causing birth defects, decreased IQ, or other disorders in your child.
• Women who are pregnant must not take divalproex sodium delayed-release capsules to prevent migraine headaches.
• All women of childbearing age (including girls from the start of puberty) should talk to their healthcare provider about using other possible treatments instead of divalproex sodiumdelayed-release capsules. If the decision is made to use divalproex sodiumdelayed-release capsules, you should use effective birth control (contraception).
• Tell your healthcare provider right away if you become pregnant while taking divalproex sodium delayed-release capsules. You and your healthcare provider should decide if you will continue to take divalproex sodium delayed-release capsules while you are pregnant.

Pregnancy Registry: If you become pregnant while taking divalproex sodium, talk to your healthcare provider about registering with the North American Antiepileptic Drug (NAAED) Pregnancy Registry. You can enroll in this registry by calling toll-free 1-888-233-2334 or by visiting the website, http://www.aedpregnancyregistry.org/. The purpose of this registry is to collect information about the safety of antiepileptic drugs during pregnancy.

3. Swelling (Inflammation) and bleeding (hemorrhaging) of your pancreas that can cause death.

Call your healthcare provider right away if you have any of these symptoms:

• severe stomach pain that you may also feel in your back
• nausea or vomiting that does not go away
• not feeling hungry

4. Like other antiepileptic drugs, divalproex sodium delayed-release capsules may cause suicidal thoughts or actions in a very small number of people, about 1 in 500.

Call a healthcare provider right away if you have any of these symptoms, especially if they are new, worse, or worry you:

• thoughts about suicide or dying
• suicide attempt
• new or worse depression
• new or worse anxiety
• feeling agitated or restless
• panic attacks
• trouble sleeping (insomnia)
• new or worse irritability
• acting aggressive, being angry, or violent
• acting on dangerous impulses
• an extreme increase in activity and talking (mania)
• other unusual changes in behavior or mood

How can I watch for early symptoms of suicidal thoughts and actions?

• Pay attention to any changes, especially sudden changes in mood, behaviors, thoughts, or feelings.
• Keep all follow-up visits with your healthcare provider as scheduled.

Call your healthcare provider between visits as needed, especially if you are worried about symptoms.

Suicidal thoughts or actions can be caused by things other than medicines. If you have suicidal thoughts or actions, your healthcare provider may check for other causes.

What are divalproex sodium delayed-release capsules?

Divalproex sodium delayed-release capsules are prescription medicines used:

• alone or with other medicines to treat:
• complex partial seizures in adults and children 10 years of age and older
• simple and complex absence seizures
• with other medications to treat:
• patients with multiple seizure types that include absence seizures

Do not take divalproex sodium delayed-release capsules if you:

• have liver problems.
• have or think you have a genetic liver problem caused by a mitochondrial disorder such as Alpers-Huttenlocher syndrome.
• are allergic to divalproex sodium, valproic acid, sodium valproate, or any of the ingredients in divalproex sodium delayed-release capsules. See the end of this Medication Guide for a complete list of ingredients in divalproex sodium delayed-release capsules.
• have a genetic problem called a urea cycle disorder.
• are taking it to prevent migraine headaches and are either pregnant or may become pregnant because you are not using effective birth control (contraception).

Before taking divalproex sodium delayed-release capsules, tell your healthcare provider about all of your medical conditions including if you:

• have or have had liver problems
• have or think you have a genetic liver problem caused by a mitochondrial disorder such as Alpers-Huttenlocher syndrome.
• drink alcohol.
• have or have had depression, suicidal thoughts or behavior, unusual changes in mood, or thoughts about self-harm
• are male and plan to father a child. Divalproex sodium delayed-release capsules may cause fertility problems, which may affect your ability to father a child. Talk to your healthcare provider if this is a problem for you.
• are pregnant or may become pregnant. Divalproex sodium may harm your unborn baby. See"2. Divalproex sodiumdelayed-release capsulesmay harm your unborn baby" above for more information.
• are breastfeeding. Divalproex sodium can pass into breast milk and may harm your baby. Talk to your healthcare provider about the best way to feed your baby if you take divalproex sodium delayed-release capsules.

Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.

Divalproex sodium delayed-release capsules may affect the way other medicines work, and other medicines may affect how divalproex sodium delayed-release capsules works. Using divalproex sodium delayed-release capsules with other medicines can cause serious side effects. Do not start or stop other medicines without talking to your healthcare provider.

Especially tell your healthcare provider if you take:

• medicines that can affect how the liver breaks down other medicines (such as phenytoin, carbamazepine, felbamate, phenobarbital, primidone, rifampin)
• aspirin, carbapenem antibiotics, or estrogen-containing hormonal contraceptives
• methotrexate
• topiramate
• cannabidiol

You can ask your healthcare provider or pharmacist for a list of these medicines if you are not sure. Know the medicines you take. Keep a list of them and show it to your healthcare provider and pharmacist each time you get a new medicine.

How should I take divalproex sodium delayed-release capsules?

• Take divalproex sodium delayed-release capsules exactly as your healthcare provider tells you. Your healthcare provider will tell you how much divalproex sodium delayed-release capsules to take and when to take it.
• Your healthcare provider may change your dose, if needed.
• Do not change your dose of divalproex sodium delayed-release capsules without talking to your healthcare provider.
• Do not stop taking divalproex sodiumdelayed-release capsuleswithout first talking to your healthcare provider. Stopping divalproex sodium delayed-release capsules suddenly can cause serious problems. See "What is the most important information I should know about divalproex sodium delayed-release capsules?".
• Divalproex sodium delayed-release capsules may be swallowed whole, or the capsule may be opened and the contents may be mixed into a small amount of soft food, such as applesauce or pudding. See the Instructions for Usethat comes with this Medication Guide for detailed instructions on how to use divalproex sodium delayed-release capsules.
• If you take too much divalproex sodium delayed-release capsules, call your healthcare provider or poison control center right away.

What should I avoid while taking divalproex sodium delayed-release capsules?

• Do notdrink alcohol while taking divalproex sodium delayed-release capsules. Divalproex sodium delayed-release capsules and alcohol can affect each other causing side effects such as sleepiness and dizziness. 
• Do not drive a car, operate dangerous machinery, or do dangerous activities until you know how divalproex sodium delayed-release capsules affects you. Divalproex sodium delayed-release capsules can slow your thinking and motor skills and may affect your vision.

What are the possible side effects of divalproex sodium delayed-release capsules?

Call your healthcare provider right away if you have any of the symptoms listed below. Your healthcare provider may do additional tests before and during your treatment with divalproex sodium delayed-release capsules. Your healthcare provider may reduce your dose, temporarily stop, or permanently stop treatment if you have certain side effects.

Divalproex sodium delayed-release capsules can cause serious side effects including:

• See "What is the most important information I should know about divalproex sodiumdelayed-release capsules?"
• bleeding problems. Call your healthcare provider if you have any symptoms of bleeding, including:

o    bruising or red or purple spots on your skin	o    vomiting blood or vomit that looks like coffee grounds
o    bleeding from your mouth or nose	o    blood in your stools or black stools (looks like tar)
o    cough up blood or blood clots	o    pain and swelling in your joints

• increased ammonia levels in your blood.High ammonia levels can seriously affect your mental activities, slow your alertness, make you feel tired, or cause vomiting (encephalopathy). This has happened when divalproex sodium delayed-release capsules are taken alone or with a medicine called topiramate. Call your health care provider if you have any of these symptoms.
• low body temperature (hypothermia).A drop in your body temperature to less than 95°F can happen during treatment with divalproex sodium delayed-release capsules. Call your healthcare provider if you have any of the following symptoms:

feeling tired	drowsiness
confusion	coma
memory loss	shivering

• severe multiorgan or skin reactions. Treatment with divalproex sodium delayed-release capsules may cause serious or life-threatening allergic reactions that may affect your skin or other parts of your body. Stop taking divalproex sodium delayed-release capsules, and contact your healthcare provider or get medical help right away, if you develop any of these symptoms:

o   skin rash	o   swelling of your lymph nodes
o   hives	o   swelling of your face, eyes, lips, tongue, or throat
o   blistering and peeling of your skin	o   trouble swallowing or breathing
o   sores in your mouth,

• drowsiness or sleepiness in the elderly.This extreme drowsiness may cause you to eat or drink less than you normally would. Tell your healthcare provider if you are not able to eat or drink as you normally do. Your healthcare provider may start you at a lower dose of divalproex sodium delayed-release capsules.
• medicine residue in your stool.Tell your healthcare provider if you have or think you may have medicine residue in your stool

The common side effects of divalproex sodium delayed-release capsules include:

headache	low blood platelet count
weakness	stomach burning, fullness, or bloating after eating
sleepiness	nausea
dizziness	vomiting
tremors	stomach pain
difficulty falling or staying asleep	diarrhea
double vision	infection
hair loss (alopecia)

These are not all of the possible side effects of divalproex sodium delayed-release capsules.

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

How should I store divalproex sodium delayed-release capsules?

• Store divalproex sodium delayed-release capsules between 68°F to 77°F (20°C to 25°C).
• Divalproex sodium delayed-release capsules come in bottles of 30 capsules and 100 capsules that use child-resistant closures and bottles of 500 capsules and 1000 capsules that do not use child-resistant closures.

Keep divalproex sodium delayed-release capsules and all medicines out of the reach of children.

General information about the safe and effective use of divalproex sodium delayed-release capsules

Medicines are sometimes prescribed for purposes other than those listed in a Medication Guide. Do not use divalproex sodium delayed-release capsules for a condition for which it was not prescribed. Do not give divalproex sodium delayed-release capsules to other people, even if they have the same symptoms that you have. It may harm them.

You can ask your pharmacist or healthcare provider for information about divalproex sodium delayed-release capsules that is written for health professionals.

What are the ingredients in divalproex sodium delayed-release capsules?

Active ingredient: divalproex sodium, USP

Inactive ingredients:

Divalproex sodium delayed-release capsules: black iron oxide, ethylcellulose, FD & C Blue 1, FD & C Red 40, gelatin, hypromellose, magnesium stearate, potassium hydroxide, shellac, sugar spheres (starch (maize), sucrose), titanium dioxide, and triethyl citrate.

Manufactured for:

First Nation Group, LLC

4566 E Highway 20,

Suite #208

Niceville, FL 32578-8839

Product of Taiwan

This Medication Guide has been approved by the U.S. Food and Drug Administration                                      

Revised: June 2025, V-01