| Migraine Disorders

Depakote vs Emgality

Side-by-side clinical, coverage, and cost comparison for migraine disorders.

Deep comparison between: Depakote vs Emgality with Prescriber.AI

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Safety signalsEmgality has a higher rate of injection site reactions vs Depakote based on FDA-approved prescribing information

Coverage gaps3 major payers require step therapy for Emgality but not Depakote, including UnitedHealthcare

Category

Depakote

Emgality

At A Glance

RouteOral

FrequencyDaily in divided doses

ClassValproate anticonvulsant

RouteSC injection

FrequencyMonthly

ClassCGRP antagonist

Indications

Bipolar Disorder
Complex partial seizures
Absence Epilepsy
Migraine Disorders

Migraine Disorders
Cluster Headache

Dosing

Bipolar Disorder 750 mg/day initially in divided doses, titrated rapidly to clinical response; max 60 mg/kg/day; oral.

Complex partial seizures 10-15 mg/kg/day initially, increased by 5-10 mg/kg/week to optimal response; max 60 mg/kg/day; divide doses if total daily dose exceeds 250 mg; oral.

Absence Epilepsy 15 mg/kg/day initially, increased at one-week intervals by 5-10 mg/kg/day until seizures are controlled; max 60 mg/kg/day; divide doses if total daily dose exceeds 250 mg; oral.

Migraine Disorders 250 mg twice daily; some patients may benefit from doses up to 1,000 mg/day; oral.

Migraine Disorders 240 mg loading dose (two consecutive SC injections of 120 mg each) once, followed by 120 mg SC monthly.

Cluster Headache 300 mg (three consecutive SC injections of 100 mg each) at the onset of the cluster period, then monthly until the end of the cluster period.

Contraindications

Hepatic disease or significant hepatic dysfunction
Mitochondrial disorders caused by mutations in mitochondrial DNA polymerase gamma (POLG; 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
Migraine prophylaxis in pregnant women or in women of childbearing potential not using effective contraception

Serious hypersensitivity to galcanezumab-gnlm or any of the excipients

Drug Interactions

1212View drug interactions

163View drug interactions

Adverse Reactions

Most common (>=5%) Nausea, vomiting, somnolence, dizziness, tremor, asthenia, alopecia, headache, abdominal pain, dyspepsia, diarrhea, weight gain

Serious Hepatic failure, birth defects, pancreatitis, hyperammonemic encephalopathy, suicidal behavior and ideation, bleeding and hematopoietic disorders, hypothermia, DRESS/multiorgan hypersensitivity, serious dermatologic reactions, angioedema

Postmarketing Toxic epidermal necrolysis, Stevens-Johnson syndrome, erythema multiforme, parkinsonism, aplastic anemia, pancytopenia, fractures, decreased bone mineral density, polycystic ovary disease, male infertility, angioedema

Most common (>=2%) Injection site reactions

Serious Hypersensitivity reactions, hypertension, Raynaud's phenomenon

Postmarketing Anaphylaxis, angioedema, rash, hypertension, Raynaud's phenomenon

Pharmacology

Divalproex sodium dissociates to the valproate ion in the gastrointestinal tract; its therapeutic mechanisms have not been fully established, but its anticonvulsant activity is thought to relate to increased brain concentrations of gamma-aminobutyric acid (GABA).

Galcanezumab-gnlm is a humanized monoclonal antibody that binds to calcitonin gene-related peptide (CGRP) ligand and blocks its binding to the receptor; it is not metabolized by cytochrome P450 enzymes, making interactions with CYP substrates, inducers, or inhibitors unlikely.

View Full FDA Information

View full FDA information

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Most Common Insurance

Anthem BCBS

Depakote