Depakote for Migraine? Weigh the Risks

Tampa, FLThe decision to discontinue taking Depakote and risk an epileptic seizure during pregnancy isn’t easy. While most doctors agree that valproic acid (Depakote) should be a last resort for pregnant women, the consensus is that seizures are worse for the babies than risking Depakote birth defects. But why prescribe the drug for migraine or bipolar disorder?

Suzanne says she tried a litany of drugs to treat migraine. Beta blockers helped but she experienced side effects such as fatigue and bowel problems so her doctor switched her to Depakote, only one of two anti-seizure medications approved for migraine prevention.

“I had an unplanned pregnancy; this may sound like I’m stupid but I didn’t know I was pregnant until my tenth week,” says Suzanne, age 42. “Some years ago I had a severe infection that required surgery and I was told that my chances of conceiving were almost impossible. I knew about Depakote birth defects but it never occurred to me that I would get pregnant, especially at my age.”

Two years ago, Suzanne’s son was born with spina bifida. She says that not a day goes by when she isn’t overcome with guilt. “Of course I stopped taking Depakote as soon as I found out that I was pregnant. I was elated with the news but also extremely worried that the damage had already been done,” she says, crying.

“My son has bowel and bladder problems and has already gone through two surgeries. He is likely going to face several more. One day I will have to tell him that his birth defect was my fault.” Depakote use in the first trimester has the highest risk of causing birth defects in children and about 1 to 2 percent of cases risk spina bifida.

Neurologists advise that women of childbearing age use alternative medications to treat their epilepsy, but any responsible doctor should never prescribe a drug with known birth defect risks to a woman who has even the remotest chance of being pregnant when there are so many safe alternatives to treat migraine.

Abbott, the manufacturer of Depakote, makes it clear on the drug’s label that it should not be used as a first line treatment for women of childbearing age. “For many women, however, Depakote may be the only effective seizure medication and that decision should be made between the patient and physician,” said Raquel Powers, a spokeswoman for Abbott. Would Powers suggest that pregnant women try another migraine medication?

The National Headache Foundation also appears to be in the dark regarding Depakote birth defect risks. Rather than stop taking Depakote, it recommends caution:

“Women who are in their childbearing years and who are contemplating pregnancy or who are not using contraception should be especially cautious with this medication as it may cause birth defects if taken during pregnancy. Women on this medication should also take Folic Acid 4 mg daily to decrease the risk of birth defects should she become pregnant.”

The FDA has designated Depakote as a schedule D drug, which means it can harm fetuses and should not be taken by pregnant women.