A Comprehensive Clinical and Pharmacological Review of Divalproex Sodium

Executive Summary

Divalproex sodium is a broad-spectrum antiepileptic agent with significant utility in the management of neurological and psychiatric disorders. Chemically, it is a stable coordination compound of sodium valproate and valproic acid, classified as a fatty acid derivative anticonvulsant.[1] Its primary indications, as approved by the U.S. Food and Drug Administration (FDA), include the treatment of acute manic or mixed episodes associated with bipolar disorder; monotherapy and adjunctive therapy for complex partial seizures and simple and complex absence seizures; and the prophylaxis of migraine headaches in adults.[3]

The therapeutic efficacy of divalproex sodium is attributed to a multifaceted mechanism of action that is not yet fully elucidated. The principal proposed mechanisms include the potentiation of inhibitory neurotransmission by increasing brain concentrations of gamma-aminobutyric acid (GABA), the modulation of voltage-gated sodium and calcium channels to stabilize neuronal membranes, and epigenetic regulation through the inhibition of histone deacetylase (HDAC) enzymes.[6] This combination of actions allows it to exert control over neuronal hyperexcitability, mood dysregulation, and nociceptive pathways.