Depakote is a medication that contains divalproex sodium. It can treat seizures, mania, and migraine headaches. Thrombocytopenia is a potential side effect.
The molecule divalproex sodium breaks down into valproate ions in your digestive tract and then interacts with a neurotransmitter in your brain called gamma-aminobutyric acid (GABA).
Some people who take Depakote experience drug-induced thrombocytopenia as a side effect. Thrombocytopenia is when your platelet count drops below a healthy range, leading to uncontrolled bleeding.
Thrombocytopenia from Depakote use often resolves itself, but your doctor may recommend switching to a different medication or lowering your dose.
Read on to learn more about the link between Depakote and thrombocytopenia.
What is Depakote-induced thrombocytopenia?
Thrombocytopenia , or a low platelet count, can develop for many reasons that can be broadly divided into inherited or acquired causes. Inherited thrombocytopenia results from genes present from birth, while acquired thrombocytopenia develops during your life.
Medication side effects are one of the most common causes of acquired thrombocytopenia. This type is also called drug-induced thrombocytopenia .
Platelets help your blood clot. People with thrombocytopenia are prone to bleeding or bruising easier than usual, even after small injuries. Symptoms tend to be worse the lower your platelet count drops. People with severely low levels are at risk of complications like internal or brain bleeding.
How does Depakote cause thrombocytopenia?
The exact reason Depakote can cause thrombocytopenia remains unclear , though it’s a well-established side effect.
Divalproex sodium contains valproic acid and sodium valproate. Your digestive tract breaks these molecules down into valproate ions that bind to a neurotransmitter in your brain called GABA.
Some researchers have suggested that valproate may directly cause thrombocytopenia in some people by reducing the production of platelets in the bone marrow. It may also stimulate the production of autoantibodies that tell your immune system to attack platelets, lowering the number of healthy platelets circulating through your blood.
Thrombocytopenia is listed as a potential adverse reaction of Depakote on the drug’s Food and Drug Administration (FDA) label. The probability of developing thrombocytopenia seems to increase significantly when the total valproate concentration in the blood rises above 110 micrograms per milliliter (mcg/mL) in females and 135 mcg/mL in males.
In one clinical trial, 27% of people taking an average of 50 milligrams per kilogram of body weight per day had a drop in their platelet count to under 75,000. About half of these people had to discontinue the medication. For the remainder, their platelet count eventually normalized.
Researchers have linked many other medications that treat seizures, migraine headaches, or psychiatric conditions to thrombocytopenia.
Keppra and thrombocytopenia
Experts reported thrombocytopenia as a complication of levetiracetam ( Keppra ) in clinical trials . Keppra can treat myoclonic seizures and generalized tonic-clonic seizures .
Seroquel and thrombocytopenia
The medication quetiapine (Seroquel) can treat bipolar disorder and schizophrenia . Thrombocytopenia can be a side effect, but it seems to be very rare.
Zyprexa and thrombocytopenia
Thrombocytopenia is listed as an infrequent complication of olanzapine (Zyprexa) on the drug’s FDA label . Zyprexa also has approval to treat bipolar disorder and schizophrenia.
Lamictal and thrombocytopenia
Lamotrigine (Lamictal) can treat epileptic seizures and bipolar disorder. Thrombocytopenia and an overall drop in your blood cell counts are potential complications .
Dilantin and thrombocytopenia
Doctors commonly prescribe phenytoin (Dilantin) to treat epileptic seizures. It may cause thrombocytopenia within 1 to 90 days after taking your first dose.
Carbatrol and thrombocytopenia
Carbamazepine (Carbatrol) can treat epilepsy and trigeminal neuralgia. Thrombocytopenia is listed as a potential complication on the drug’s FDA label .
Klonopin and thrombocytopenia
Clonazepam (Klonopin) is another potential trigger of thrombocytopenia. It can treat seizures and panic disorder .
Other side effects of Depakote
The most common side effects of Depakote include:
When to get medical help
It’s important to get medical help if you develop any symptoms of thrombocytopenia , such as:
- easy or excessive bleeding or bruising
- prolonged or frequent nosebleeds
- heavy menstruation
- frequent gum bleeding
- pinpoint reddish-purple spots called petechiae , usually on your lower legs
It’s essential to get emergency medical help if you or somebody you’re with develops symptoms of thrombocytopenia as well as symptoms of a life threatening complication called thrombotic thrombocytopenic purpura .
Call the emergency medical services or go to the nearest emergency room if you develop the following, which can come on suddenly:
- extreme and sudden fatigue
- fever
- headache
- stroke
- seizure
- confusion
- coma
Valproic-acid-induced thrombocytopenia treatment
If you develop drug-induced thrombocytopenia, a doctor may recommend switching to another medication or lowering your dose. Thrombocytopenia seems to be less common at lower doses .
Thrombocytopenia usually starts to improve after 4 to 5 half-lives of the medication after you stop taking it. The half-life of valproate is about 9 to 16 hours , so your platelet levels may start to improve after about 1.5 to 3 days.
Takeaway
Thrombocytopenia is a potential complication of the medication Depakote. Some people who develop thrombocytopenia may need to stop taking the medication, while others may be able to continue.
It’s important to contact a doctor if you think you may have thrombocytopenia. They can run tests to measure your platelet count and determine if your condition needs treatment.
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