Q:  Depakote ER & Liver Pain

Dr Phelps,
I was on Depakote ER for about a month (dose was titrated up to 1,000mg per day) and my liver started to hurt (felt like a minor gallstone attack.  I had my gallbladder removed several years ago after I had gallstone attacks).  They couldn't find any stones, but my liver enzymes were 2-3X normal.

At the advise of my medical doctor, I discontinued the Depakote and the pain subsided.  I went back on the Depakote ER at 500mg/day about 3 weeks later (after a subsequent liver test came back normal) and the liver pain started again.

My question is, can I safely take Depakote ER even though my liver hurts a little?  It controls my moods so well (I rapid cycle) that I really want to be able to take it.
 

Dear Ms. B' -- 
Your doctor will help you decide how much risk to take; make sure she/he knows you're having that pain again.  In almost all cases we stop the medication for liver enzymes > 3 times normal, often below that, and the pain is a particularly concerning sign.  Sorry to say.  Fortunately, there are quite a few alternatives (here's my working list). 

There is at least one case report of carnitine helping someone get past liver irritation, e.g. this report by Romero-Falcon; ask your doctor about that.  I've never had to use this strategy, nor do I hear about it much.  I actually stumbled on it searching up information on carnitine for another inquiry here on this website.  Your doctor can ask Abbott Labs, who make Depakote, to provide her more information on use of carnitine in this way (she can ask her local Abbott representative for this; the request has to come directly from her for that information to be forwarded to her).  

Dr. Phelps

Published June, 2004