| Migraine Disorders
Depakote vs Relpax
Side-by-side clinical, coverage, and cost comparison for migraine disorders.Deep comparison between: Depakote vs Relpax 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 signalsRelpax has a higher rate of injection site reactions vs Depakote based on FDA-approved prescribing information
Coverage gaps3 major payers require step therapy for Relpax but not Depakote, including UnitedHealthcare
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Category
Depakote
Relpax
At A Glance
Oral
Daily in divided doses
Valproate anticonvulsant
Oral
As needed
5-HT1B/1D agonist (triptan)
Indications
- Bipolar Disorder
- Complex partial seizures
- Absence Epilepsy
- Migraine Disorders
- Migraine Disorders
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 20 mg or 40 mg orally for acute treatment; a second dose may be taken at least 2 hours after the first if migraine has not resolved or returns; maximum 80 mg/day.
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
- Ischemic coronary artery disease (angina pectoris, history of myocardial infarction, or documented silent ischemia) or coronary artery vasospasm, including Prinzmetal's angina
- Wolff-Parkinson-White syndrome or arrhythmias associated with other cardiac accessory conduction pathway disorders
- History of stroke, transient ischemic attack (TIA), or history or current evidence of hemiplegic or basilar migraine
- Peripheral vascular disease
- Ischemic bowel disease
- Uncontrolled hypertension
- Recent use (within 24 hours) of another 5-HT1 agonist, ergotamine-containing medication, or ergot-type medication such as dihydroergotamine (DHE) or methysergide
- Hypersensitivity to eletriptan or any excipient (angioedema and anaphylaxis seen)
- Recent use (within at least 72 hours) of potent CYP3A4 inhibitors: ketoconazole, itraconazole, nefazodone, troleandomycin, clarithromycin, ritonavir, or nelfinavir
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%) Asthenia, nausea, dizziness, somnolence, headache, paresthesia, flushing/feeling of warmth, chest tightness/pain/pressure, abdominal pain/discomfort, dry mouth, dyspepsia, dysphagia
Serious Myocardial ischemia and myocardial infarction, Prinzmetal's angina, arrhythmias, chest/throat/neck/jaw pain/tightness/pressure, cerebrovascular events, vasospasm reactions, medication overuse headache, serotonin syndrome, increase in blood pressure, hypersensitivity reactions
Postmarketing Seizure, vomiting
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).
Eletriptan is a selective 5-HT1B/1D receptor agonist (triptan) that acts on intracranial blood vessel receptors and trigeminal sensory nerves to produce cranial vessel constriction and inhibit pro-inflammatory neuropeptide release.
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Most Common Insurance
Anthem BCBS
Depakote
- Covered on 5 commercial plans
- PA (0/12) · Step Therapy (0/12) · Qty limit (9/12)
Relpax
- Covered on 5 commercial plans
- PA (3/12) · 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)
Relpax
- Covered on 4 commercial plans
- PA (0/8) · Step Therapy (2/8) · Qty limit (7/8)
Humana
Depakote
- Covered on 0 commercial plans
- PA (0/3) · Step Therapy (0/3) · Qty limit (0/3)
Relpax
- Covered on 0 commercial plans
- PA (1/3) · 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 Relpax.
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Clinical data sourced from FDA-approved labeling. Coverage data via MMIT. Updated monthly.