| Migraine Disorders
Depakote vs Trokendi XR
Side-by-side clinical, coverage, and cost comparison for migraine disorders.Deep comparison between: Depakote vs Trokendi Xr 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 signalsTrokendi Xr has a higher rate of injection site reactions vs Depakote based on FDA-approved prescribing information
Coverage gaps3 major payers require step therapy for Trokendi Xr but not Depakote, including UnitedHealthcare
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Category
Depakote
Trokendi Xr
At A Glance
Oral
Daily in divided doses
Valproate anticonvulsant
Oral
Once daily
Anticonvulsant; carbonic anhydrase inhibitor
Indications
- Bipolar Disorder
- Complex partial seizures
- Absence Epilepsy
- Migraine Disorders
- Lennox-Gastaut Syndrome
- 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.
Lennox-Gastaut Syndrome Adjunctive therapy: adults (>=17 years) 200-400 mg orally once daily, initiated at 25-50 mg once daily and titrated in 25-50 mg/week increments; pediatric patients 6-16 years approximately 5-9 mg/kg/day orally once daily, initiated at 25 mg/day and titrated at 1-3 mg/kg/day every 1-2 weeks, not to exceed 400 mg/day.
Migraine Disorders Preventive treatment for patients 12 years and older: 100 mg orally once daily, titrated over 4 weeks starting at 25 mg/day (Week 1: 25 mg, Week 2: 50 mg, Week 3: 75 mg, Week 4: 100 mg).
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
- Recent alcohol use within 6 hours prior to or 6 hours after TROKENDI XR administration
- History of hypersensitivity reaction to topiramate, TROKENDI XR, or any inactive ingredient (anaphylaxis and angioedema have occurred)
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 (>=10%) Paresthesia, weight loss, anorexia, dizziness, somnolence, nervousness, psychomotor slowing, speech disorders, vision abnormal
Serious Acute myopia and secondary angle closure glaucoma, metabolic acidosis, oligohydrosis and hyperthermia, suicidal behavior and ideation, fetal toxicity, DRESS/multiorgan hypersensitivity, serious skin reactions, anaphylaxis and angioedema, hyperammonemia and encephalopathy, decrease of bone mineral density, kidney stones
Postmarketing Hepatic failure, hepatitis, pancreatitis, Stevens-Johnson syndrome, toxic epidermal necrolysis, pemphigus, nephrocalcinosis, maculopathy, decreased INR with vitamin K antagonists
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).
Topiramate is a sulfamate-substituted monosaccharide anticonvulsant whose precise mechanism is unknown but is believed to involve blockade of voltage-dependent sodium channels, augmentation of GABA-A receptor activity, antagonism of AMPA/kainate glutamate receptors, and inhibition of carbonic anhydrase isozymes II and IV.
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)
Trokendi Xr
- Covered on 5 commercial plans
- PA (5/12) · 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)
Trokendi Xr
- Covered on 4 commercial plans
- PA (1/8) · Step Therapy (0/8) · Qty limit (0/8)
Humana
Depakote
- Covered on 0 commercial plans
- PA (0/3) · Step Therapy (0/3) · Qty limit (0/3)
Trokendi Xr
- 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 Trokendi Xr.
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Clinical data sourced from FDA-approved labeling. Coverage data via MMIT. Updated monthly.