| Epilepsy
Depakote ER vs Lyrica
Side-by-side clinical, coverage, and cost comparison for epilepsy.Deep comparison between: Depakote vs Lyrica with Prescriber.AI
AI compares prescribing info and payer-specific access barriers across 1,200+ formularies. Here's a preview of what prescribers are already asking.Safety signalsLyrica has a higher rate of injection site reactions vs Depakote based on FDA-approved prescribing information
Coverage gaps3 major payers require step therapy for Lyrica but not Depakote, including UnitedHealthcare
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Category
Depakote
Lyrica
At A Glance
Oral
Once daily
Valproate anticonvulsant
Oral
2-3 times daily
alpha2-delta calcium channel ligand
Indications
- Bipolar Disorder
- Epilepsy
- Absence Seizures
- Peripheral Nervous System Diseases
- Epilepsy
- Fibromyalgia
- chronic pain (diagnosis)
Dosing
Bipolar Disorder Initial dose 25 mg/kg/day once daily, titrated to clinical response (trough 85-125 mcg/mL); maximum 60 mg/kg/day.
Epilepsy Initial dose 10-15 mg/kg/day once daily, increased by 5-10 mg/kg/week to optimal response; maximum 60 mg/kg/day.
Absence Seizures Initial dose 15 mg/kg/day, increased weekly by 5-10 mg/kg/day until seizures are controlled; maximum 60 mg/kg/day.
Migraine prophylaxis 500 mg once daily for 1 week, then 1,000 mg once daily.
Peripheral Nervous System Diseases Begin at 150 mg/day in 3 divided doses; may increase to max 300 mg/day within 1 week; oral.
chronic pain (diagnosis) PHN: begin at 150 mg/day (75 mg BID or 50 mg TID), max up to 600 mg/day. Spinal cord injury neuropathic pain: begin at 150 mg/day (75 mg BID), max 600 mg/day; oral.
Epilepsy Adults: begin at 150 mg/day in 2 or 3 divided doses, max 600 mg/day. Pediatric >=30 kg: begin 2.5 mg/kg/day, max 10 mg/kg/day. Pediatric <30 kg: begin 3.5 mg/kg/day, max 14 mg/kg/day; oral.
Fibromyalgia Begin at 150 mg/day (75 mg BID); may increase to 300 mg/day within 1 week; max 450 mg/day; oral.
Contraindications
- Hepatic disease or significant hepatic dysfunction
- Known mitochondrial disorders caused by POLG mutations (e.g., Alpers-Huttenlocher Syndrome) and children under two years of age suspected of having a POLG-related disorder
- Known hypersensitivity to divalproex sodium, sodium valproate, or valproic acid
- Known urea cycle disorders
- Pregnancy or women of childbearing potential not using effective contraception (migraine prophylaxis indication only)
- Known hypersensitivity to pregabalin or any of its components
Adverse Reactions
Most common (>=5%) Somnolence, nausea, vomiting, diarrhea, dizziness, tremor, asthenia, dyspepsia, abdominal pain, alopecia, thrombocytopenia
Serious Hepatic failure, pancreatitis, hyperammonemic encephalopathy, suicidal behavior and ideation, thrombocytopenia, birth defects and neurodevelopmental disorders (in utero exposure), hypothermia, DRESS/multiorgan hypersensitivity, serious dermatologic reactions, angioedema
Postmarketing Toxic epidermal necrolysis, Stevens-Johnson syndrome, erythema multiforme, aplastic anemia, agranulocytosis, pancytopenia, decreased bone mineral density, osteoporosis, acute cognitive decline, encephalopathy, polycystic ovary disease, Fanconi syndrome
Most common (>=5%) Dizziness, somnolence, dry mouth, edema, blurred vision, weight gain, thinking abnormal
Serious Angioedema, hypersensitivity, suicidal behavior and ideation, respiratory depression, peripheral edema, weight gain, tumorigenic potential, ophthalmological effects, creatine kinase elevations, decreased platelet count, PR interval prolongation
Postmarketing Headache, nausea, diarrhea, gynecomastia, breast enlargement, bullous pemphigoid, life-threatening respiratory depression with opioids or CNS depressants
Pharmacology
Divalproex sodium dissociates to the valproate ion in the gastrointestinal tract; its antiepileptic activity is thought to be related to increased brain concentrations of gamma-aminobutyric acid (GABA), though the precise mechanism of therapeutic action has not been established.
Pregabalin binds with high affinity to the alpha2-delta site (an auxiliary subunit of voltage-gated calcium channels) in CNS tissues, reducing calcium-dependent release of pro-nociceptive neurotransmitters in the spinal cord and exerting antiseizure effects; it is a structural GABA analogue but does not act directly on GABA receptors, sodium channels, or opiate receptors.
Enter your patient's insuranceCheck specific coverage details for your patient.
Most Common Insurance
Anthem BCBS
Depakote
- Covered on 5 commercial plans
- PA (0/12) · Step Therapy (0/12) · Qty limit (9/12)
Lyrica
- Covered on 5 commercial plans
- PA (0/12) · Step Therapy (0/12) · Qty limit (9/12)
UnitedHealthcare
Depakote
- Covered on 4 commercial plans
- PA (0/8) · Step Therapy (0/8) · Qty limit (0/8)
Lyrica
- Covered on 4 commercial plans
- PA (0/8) · Step Therapy (0/8) · Qty limit (4/8)
Humana
Depakote
- Covered on 0 commercial plans
- PA (0/3) · Step Therapy (0/3) · Qty limit (0/3)
Lyrica
- Covered on 0 commercial plans
- PA (0/3) · Step Therapy (0/3) · Qty limit (3/3)
Coverage data sourced from MMIT. Updated monthly.
Savings
No savings programs available for Depakote.
No savings programs available for Lyrica.
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Next Steps for Your Patient
DepakoteView full Depakote profile
LyricaView full Lyrica profile
Clinical data sourced from FDA-approved labeling. Coverage data via MMIT. Updated monthly.