Depakene may potentiate the CNS depressant activity of alcohol.
The concomitant administration of valproic acid with drugs that exhibit extensive protein-binding (eg, aspirin, carbamazepine and dicumarol) may result in alteration of serum drug levels.
There is evidence that Depakene can cause an increase in serum phenobarbital levels by impairment of nonrenal clearance. This phenomenon can result in severe CNS depression. The combination of Depakene and phenobarbital has also been reported to produce CNS depression without significant elevations of barbiturate or valproate serum levels. All patients receiving concomitant barbiturate therapy should be closely monitored for neurological toxicity. Serum barbiturate levels should be obtained, if possible, and the barbiturate dosage decreased, if appropriate.
Primidone is metabolized into a barbiturate and therefore, may also be involved in a similar or identical interaction.
There have been reports of breakthrough seizures occurring with the combination of Depakene and phenytoin. Most reports have noted a decrease in total plasma phenytoin concentration. However, increases in total phenytoin serum concentration have been reported. An initial fall in total phenytoin levels with subsequent increase in phenytoin levels has also been reported. In addition, a decrease in total serum phenytoin with an increase in the free versus protein-bound phenytoin levels has been reported. The dosage of phenytoin should be adjusted as required by the clinical situation.
The concomitant use of valproic acid and clonazepam may produce absence status.
There is inconclusive evidence regarding the effect of valproate on serum ethosuximide levels. Patients receiving valproate and ethosuximide levels. Patients receiving valproate and ethosuximide, especially along with other anticonvulsants, should be monitored for alterations in serum concentrations of both drugs.
Caution is recommended when Depakene is administered with drugs affecting coagulation eg, aspirin and warfarin. (See Adverse Reactions.)