Divalproex is indicated for the treatment of patients with acute mania. This agent also is associated with potential side effects, carries three black box warnings, and requires therapeutic blood monitoring. Therapeutic serum levels range from 50 ng/mL to 125 ng/mL. When initiating patients on divalproex therapy, a loading dose of between 20 mg per kilogram of body weight and 30 mg per kilogram of body weight should be used.
Adverse effects associated with divalproex include both dose-related and nondose-related effects. Dose-related effects include nausea, diarrhea, fatigue, drowsiness, thrombocytopenia, and cognitive dulling. Nondose-related effects include weight gain, tremor, hair loss, pancreatitis, hepatotoxicity, and teratogenicity.