• If you are allergic to anything, including medicines, dyes, additives, or foods.

• If you have or have ever had liver disease, including hepatitis. You may not be able to take any of these drugs. If you do take one, you may need to be watched more carefully since they can damage the liver.

• If you have or have ever had pancreatitis (inflamed pancreas). The valproic acid drugs can sometimes cause a severe type of pancreatitis.

• If you have any genetic (inborn) disease that affects urea cycles in the body, or if you have brain disease. You may not be able to take these drugs, since they can greatly increase your risk of serious harmful effects.

• If you or a relative have had an allergy or organ sensitivity (for example, severe skin rash or major liver problem) with any anti-seizure drug. This may suggest an increased risk of having a similar problem when taking valproic acid drugs.

• If you are pregnant, trying to get pregnant, or if there is any chance of pregnancy. The valproic acid drugs may cause birth defects if either the male or female is taking one at the time of conception or during pregnancy, especially if the woman is taking it during the first 3 months of pregnancy. Men and women who are taking any of these drugs need to use some kind of birth control during treatment. It is important to check with your doctor about what kinds of birth control can be used with it.

• If you are breast-feeding. Valproic acid drugs pass into breast milk and can affect the baby.

• About any other prescription or over-the-counter medicines you are taking, including vitamins and herbs. In fact, keeping a written list of each of these medicines (including the doses of each and when you take them) with you in case of emergency may help prevent complications if you get sick.

The anti-seizure drugs carbamazepine, phenytoin, phenobarbital, and primidone may lower the blood level of valproic acid so that it doesn't work properly. Certain antibiotics, such as ertapenem (Invanz), imipenem (Primaxin), meropenem (Merrem) may reduce the blood levels of valproic acid drugs so that they don't work properly. Rifampin (a TB treatment) may cause the same problem.

The following medicines can build up in the body while you are taking the valproic acid drugs, raising the risk of harmful side effects:

• anti-seizure drugs such as lamotrigine, phenobarbital, ethosuximide
• antidepressants such as amitriptyline, nortriptyline
• tranquilizer/sedative: diazepam
• HIV treatment: zidovudine (AZT)

The following drugs can have worse effects on the body if you are also taking a valproic acid drug:

• tranquilizer/sedative clonazepam may worsen "absence" type seizures
• anti-seizure drug topiramate (Topamax) may raise the risk of serious effects on the brain
• other anti-seizure drugs taken with valproic acid can raise the risk of liver damage
• blood thinner: warfarin (bleeding times may be affected, can raise your risk of bleeding)

Pain medicines of the non-steroidal anti-inflammatory type (such as ibuprofen, ketaprofen, naproxen, nabumetone, etodolac, sulindac, indomethacin, etc.) and other medicines that can cause stomach ulcers may increase your risk of bleeding ulcers while you are taking valproic acid drugs.

Medicines that prevent blood from clotting, such as heparin or persantine, may increase your risk of serious bleeding.

Medicines that slow down the brain or nervous system, such as opioid pain relievers, tranquilizers, sedatives, sleeping pills, antidepressants, muscle relaxers, antihistamines, phenothiazines, anesthetic medicines, and alcohol can cause worse effects if taken with valproic acid drugs.

Check with your doctor, nurse, or pharmacist about whether other medicines, vitamins, herbs, and supplements can cause problems with this medicine.

Divalproex extended release tablets must be swallowed whole, and not broken, crushed, dissolved or chewed.

Divalproex "sprinkles" are coated particles that come in a capsule. The capsule can be swallowed whole, or it can be opened and the particles sprinkled on a spoonful of soft food such as pudding or applesauce. The food must be swallowed right away, without chewing. Rinse your mouth with water afterward in order to wash down and swallow any remaining particles without chewing them. If the food containing the drug is not eaten right away, flush it down the toilet. Do not save it for later.

Valproic acid comes in capsules and syrup. The capsules should be swallowed whole to avoid irritating the mouth and throat. The syrup form can be mixed into food or drinks to improve the taste.

Valproate sodium may be given by injection (shot) or infusion if you are unable to take pills or liquids by mouth.

Take this drug exactly as directed by your doctor. If you do not understand the instructions, ask your doctor or nurse to explain them to you. Keep the medicine in a tightly closed container away from heat and moisture and out of the reach of children, pets, or others. Keep this medicine from freezing. Medicine that will not be used should be flushed down the toilet as soon as possible.

Call your doctor if you plan to start or stop any other medicine, vitamin, or supplement while on valproic acid drugs. Your dose of one or more medicines may need to be changed due to possible drug interactions.

Valproic acid drugs can cause severe damage to the liver or pancreas in a few people. Your doctor will likely check liver function by doing blood tests while you are taking the medicine. Call your doctor right away if you notice nausea, vomiting, pain in your belly or below your rib cage, poor appetite, weakness, tiredness, swelling of the face or eyes, dark (cola-colored) urine, or yellowing of the skin or eyes.

If you notice strange or unusual thoughts or behavior while on this medicine, call your doctor. Some people start to think about suicide and may hurt themselves. Rarely, people get confused, agitated, or start seeing or hearing things that are not there. Tell family members, loved ones, and caregivers that you are taking this drug so that they can help you if they notice behavior changes.

Call your doctor right away if you develop a rash or blistering, fever, muscle aches, sores in your mouth or throat, or swollen glands. These can be early signs of a serious reaction that needs to be treated quickly.

If you notice confusion, hallucinations, trouble walking or talking, tremors, poor coordination, trouble with your vision, extreme sleepiness, or other effects on the brain, contact your doctor right away.

The valproic acid drugs may increase your risk of bleeding. Tell your doctor or nurse right away if you have unusual bruising, or bleeding such as nosebleeds, bleeding gums when you brush your teeth, or black, tarry stools.

If you are having surgery, let the doctor or dentist in charge know you are taking this medicine. It may affect your bleeding during the procedure.

If you are using a valproic acid drug for chronic (long term) cancer pain, talk with your doctor or nurse about taking your pain medicines on a regular schedule to keep it from worsening. If you wait until the pain is bad, it takes more medicine to get it under control. If pain comes back between doses, talk to your cancer team about changing your medicine or adding an extra one for "breakthrough" pain.

Most cancer pain can be controlled. Keep your doctor or nurse informed about how well your pain medicines are working and any side effects you are having. Your cancer team may need to adjust your medicines several times before they find the medicines that work best for you.

These drugs may affect some lab test results. Tell all doctors and dentists you are taking this medicine before you have lab work done.

A few people are allergic to this medicine and may have symptoms such as shortness of breath, faintness, trouble swallowing, itching, skin welts, or swelling of the face, nose, or mouth. If this happens, get emergency help.

• nausea*
• vomiting*
• headache
• sleepiness*
• tremor*
• weakness*

• dizziness*
• heartburn
• diarrhea
• belly pain*
• blurred vision or seeing double*
• flu symptoms (fever, muscle aches)*

• trouble walking*
• poor coordination*
• poor appetite or increased appetite
• weight loss or weight gain
• constipation
• low platelet count with increased risk of bleeding*
• low red blood cell count (anemia) with weakness, poor energy
• severe liver damage*
• confusion*
• hallucinations*
• trouble talking*
• trouble thinking*
• coma
• severe rash with fever, mouth sores, and other symptoms*
• allergic reaction*
• suicidal thoughts or actions
• thinning hair
• increased risk of brith defects (such as spina bifida) in the offspring of women who take valproic acid drugs during pregnancy.

*See the "Precautions" section for more detailed information.