Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes Epival (Divalproex). If you are concerned about side effects, discuss the risks and benefits of Epival (Divalproex) with your doctor.

The following side effects have been reported by at least 1% of people taking Epival (Divalproex). Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

• Diarrhea
• dizziness
• headache
• indigestion or heartburn
• nausea
• sleepiness
• vomiting
• weakness

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

• changes in hair (hair loss or increased hair on face, chest, and back)
• hallucinations
• increase in seizures
• increasing tiredness and weakness with behaviour changes (extreme irritability, combativeness)
• nausea or vomiting (continuing)
• signs of bleeding (e.g., unusual nosebleeds, bruising, blood in urine, coughing blood, bleeding gums, cuts that don't stop bleeding)
• signs of depression (e.g., poor concentration, changes in weight, changes in sleep, decreased interest in activities, thoughts of suicide) or other mood changes
• signs of liver problems (e.g., nausea, vomiting, diarrhea, loss of appetite, weight loss, yellowing of the skin or whites of the eyes, dark urine, pale stools)
• signs of muscle damage (e.g., muscle pain, tenderness or weakness, or brown or discoloured urine) - especially if you also have a Fever or a general feeling of being unwell
• tremor

Seek immediate medical attention if any of the following occur:

• signs of pancreatitis (e.g., abdominal pain on the upper left side, back pain, nausea, fever, chills, rapid heartbeat, swollen abdomen)
• severe skin reactions on a large area of the body or on the lips (e.g., ulcers, blisters, pain, redness, skin peeling)
• signs of a serious allergic reaction (e.g., abdominal cramps, difficulty breathing, nausea and vomiting, or swelling of the face and throat)
• thoughts of hurting yourself or others

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking Epival (Divalproex).

125 mg
Each enteric-coated, salmon-pink tablet contains Epival (Divalproex) sodium equivalent to 125 mg of Valproic acid. Nonmedicinal ingredients: cellulosic polymers, diacetylated monoglycerides, FD&C Red No. 40, povidone, pregelatinized starch (contains cornstarch), silicon dioxide, talc, titanium dioxide, and vanillin. Alcohol-, gluten-, lactose-, paraben-, sucrose-, sulfite-, and tartrazine-free.

250 mg
Each enteric-coated, peach-coloured tablet contains Epival (Divalproex) sodium equivalent to 250 mg of valproic acid. Nonmedicinal ingredients: cellulosic polymers, diacetylated monoglycerides, FD&C Yellow No. 6, povidone, pregelatinized starch (contains cornstarch), silicon dioxide, talc, titanium dioxide, and vanillin. Alcohol-, gluten-, lactose-, paraben-, sucrose-, sulfite-, and tartrazine-free.

500 mg
Each enteric-coated, pink-coloured tablet contains Epival (Divalproex) sodium equivalent to 500 mg of valproic acid. Nonmedicinal ingredients: cellulosic polymers, D&C Red No. 30, diacetylated monoglycerides, FD&C Blue No. 2, povidone, pregelatinized starch (contains cornstarch), silicon dioxide, talc, titanium dioxide, and vanillin. Alcohol-, gluten-, lactose-, paraben-, sucrose-, sulfite-, and tartrazine-free.

Do not take Epival (Divalproex) if you:

• are allergic to valproic acid, Epival (Divalproex), or any ingredients of the medication
• have been diagnosed with a urea cycle disorder
• have liver disease or a significant reduction in liver function
• have Alpers syndrome or Alpers-Huttenlocher syndrome, conditions caused by nervous system breakdown
• have porphyria
• are pregnant and are taking Epival (Divalproex) for Epilepsy unless there is no suitable alternative for seizure management
• are pregnant and are taking this mediation for bipolar disorder
• are a woman of child-bearing age and cannot follow the recommended birth control measures

There may be an interaction between Epival (Divalproex) and any of the following:

• Acarbose
• Acetazolamide
• alcohol
• antipsychotic medications (e.g., Chlorpromazine, Haloperidol, Olanzapine, Perphenazine, Risperidone)
• Asa (acetylsalicylic acid)
• barbiturates (e.g., butalbital, pentobarbital, Phenobarbital)
• benzodiazepines (e.g., Clonazepam, Diazepam, Lorazepam)
• birth control pills (estrogens)
• Bismuth Subsalicylate
• cannabis
• Carbamazepine
• Cholestyramine
• Cimetidine
• ertapenem
• Guanfacine
• HIV protease inhibitors (e.g., atazanavir, indinavir, ritonavir, saquinavir)
• imipenem
• Irinotecan
• isoniazid
• Lamotrigine
• lomustine
• macrolide antibiotics (e.g., clarithromycin, erythromycin)
• Mefloquine
• Minoxidil
• monoamine oxidase inhibitors (M.O.S. e.g., Moclobemide, Phenelzine, Rasagiline, Selegiline, Tranylcypromine)
• meropenem
• Orlistat
• Oxcarbazepine
• Phenytoin
• primidone
• rifampin
• Rufinamide
• selective serotonin reuptake inhibitors (SSRIs; e.g., Citalopram, Fluoxetine, Paroxetine, Sertraline)
• Tolbutamide
• Topiramate
• tricyclic antidepressants (e.g., Amitriptyline, Nortriptyline)
• Vorinostat
• Warfarin
• zidovudine

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with Epival (Divalproex). Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the Nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

Before you begin using a medication, be sure to inform your doctor of any medical conditions or Allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use Epival (Divalproex).

Behaviour changes: People taking Epival (Divalproex) have occasionally experienced aggressive behaviour or hostility, anxiousness, disorientation, or decreased memory. If you experience any of these effects or notice them in a family member who is taking Epival (Divalproex), contact your doctor as soon as possible.

Blood clotting: Epival (Divalproex) may make it more difficult for the blood to clot. If you take anticoagulant medications (blood thinning) medications, discuss with your doctor how Epival (Divalproex) may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Epival (Divalproex), and whether any special monitoring is needed. If you notice any signs of bleeding, such as frequent nosebleeds, unexplained bruising, or black and tarry stools, notify your doctor as soon as possible. Your doctor will order routine blood tests to make sure potential problems are caught early.

Drowsiness/reduced alertness: Epival (Divalproex) may cause drowsiness, especially when combined with alcohol or another sedating medication. Avoid driving or other potentially dangerous activities until you determine how Epival (Divalproex) affects you.

Hypersensitivity reaction: A Anaphylaxis (severe allergic reaction) called hypersensitivity reaction has occurred on rare occasions for some people with the use of Epival (Divalproex), as well as other medications to treat seizures. This reaction involves a number of organs in the body and may be fatal if not treated quickly. Stop taking the medication and get immediate medical attention if you have symptoms of a severe allergic reaction, including fever, swollen glands, yellowing of the skin or eyes, or flu-like symptoms with skin rash or blistering.

Kidney Disease: Kidney disease or reduced kidney function may cause Epival (Divalproex) to build up in the body, causing side effects. If you have reduced kidney function or kidney disease, discuss with your doctor how Epival (Divalproex) may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Epival (Divalproex), and whether any special monitoring is needed.

Liver function: Liver failure has occurred infrequently for people taking Epival (Divalproex). In most cases, this has happened during the first 6 months of treatment. The risk is highest for children under the age of 2 years, especially those who take more than one antiseizure medication, or those who have certain medical conditions (e.g., metabolic disorders, brain disease, severe seizure disorders accompanied by mental retardation). Children aged 3 to 10 years are also at a higher risk if they take more than one antiseizure medication. Liver function tests should take place before starting treatment with Epival (Divalproex). Your doctor may also perform liver function tests regularly to monitor the function of your liver. Serious liver problems may happen after symptoms such as loss of seizure control, malaise, weakness, lethargy, loss of appetite, and vomiting. People who take valproic acid should tell their doctor at once if they experience these symptoms. Increases in the levels of ammonia in the blood, with or without lethargy or coma, have been reported and may be present despite normal liver function tests.

Pancreatitis: People taking Epival (Divalproex) have experienced life-threatening pancreatitis (inflammation of the pancreas). These cases have occurred shortly after starting the medication and after several years of taking the medication. If you experience signs of pancreatitis such as abdominal pain on the upper left side, back pain, loss of appetite, nausea, fever, chills, rapid heartbeat, or swollen abdomen, contact your doctor immediately.

Suicidal thoughts: There is a small risk that Epival (Divalproex) may result in thoughts of suicide. If you experience these symptoms or any other behaviour change while taking Epival (Divalproex), contact your doctor immediately. Family members or caregivers of people who are taking Epival (Divalproex) should contact the person's doctor immediately if they notice unusual behaviour changes.

Stopping Epival (Divalproex): People who need Epival (Divalproex) to prevent major seizures should not stop taking it suddenly as this can increase the risk of getting seizures. Do not stop taking Epival (Divalproex) without consulting with your doctor first.

Pregnancy: There is an increased risk of serious birth defects for a child whose mother takes Epival (Divalproex) during pregnancy. Epival (Divalproex) may cause a number of defects including a defect of the spine called Spina Bifida, cleft palate, heart defects, Autism, or slowed or reduced mental development. Epival (Divalproex) should not be used during pregnancy for treatment of epilepsy unless there is no other suitable alternative treatment. Epival (Divalproex) should not be used during pregnancy for treatment of bipolar disorder. Women of child-bearing age must use effective contraception while taking Epival (Divalproex).

Before becoming pregnant, women who are taking Epival (Divalproex) should speak to their doctor. If possible, a switch to another medication to treat epilepsy should be considered. If you become pregnant while taking Epival (Divalproex), contact your doctor immediately.

Breast-feeding: Epival (Divalproex) passes into breast milk. If you are a breast-feeding mother and are taking Epival (Divalproex), it may affect your baby. Talk to your doctor about whether you should continue breast-feeding. As a general rule, women who are taking Epival (Divalproex) should not breast-feed.

Children: If Epival (Divalproex) is taken by children 2 years old or younger, it should not be used in combination with other antiseizure medications and the doctor should monitor the child regularly. Epival (Divalproex) is not recommended for treatment of mania in children under 18 years of age.

Seniors: People over the age of 65 may be more at risk of developing side effects from Epival (Divalproex) and may require lower dosages.