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Can I substitute divalproex sodium tablets for cambia 50 mg…

Can I substitute divalproex sodium...
Can I substitute divalproex sodium tablets for cambia 50 mg dose. If so how much divalproex sodium do I take to equal the 50 mg dose and do I crust the divalproex sodium tablets and drink it or just take a tablet?
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Answered in 17 minutes by:
3/18/2018
Dr Subbanna MD
Dr Subbanna MD, Neurologist (MD)
Category: Neurology
Satisfied Customers: 6,422
Experience: American Board Certified Neurologist, Internal Medicine
Verified

Hi, I am an American Board Certified Neurologist with vast experience in diagnosing & treating all neurological as well as all other health/medical conditions, and I am very glad to help you with your health concerns.

I see you have questions regarding using Divalproex sodium in place of Cambia. As a Neurologist I prescribe these medications very frequently & I am very familiar with these medications, and I can certainly help you in this regard.

First I need to ask few questions so that I can gather more information related to your health concerns, kindly answer to these below posted questions, it will help me in gathering additional information related to your health concerns;

1) What is the health condition for which you have already been using cambia, and also intend to use divalproex sodium in the future? Is it for migraine, or for some other health condition?

2) How much cambia are you on now, is it 50 mg?

3) What is the reason for considering switching cambia to divaloproex sodium? Any side effect with cambia, or is it not helping, or any other reason?

Kindly reply

Best Regards!

Dr Subbanna MD

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Customer reply replied 5 months ago
Migraine headaches is the health condition. I am currently taking 50mg of cambia. And I am considering switching due to cost. My insurance does not cover cambia at all but a divalproex prescription is free for me.

Okay I see. I appreciate for all these additional information. Can I also ask;

1) Have you tried any other medications for migraine so far (other than cambia)? If please try to give me a list of all treatments that have been tried so far to help with migraine in addition to using cambia

2) And also how often you get migraine attacks?

3) How much was cambia helping you?

Kindly reply

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Customer reply replied 5 months ago
Have taken imitrex, fioricet, and they helped some. I usually have about 8 headaches a month.the cambia was a huge help. It actually got rid of my headaches.

Okay I see. I appreciate for all these additional information. I see cambia was of so much help but sorry to see due to insurance reason you may now have to unfortunately stop it, Can I also ask;

1) Imitrex, fioricet, cambia etc are used for treating acute attacks of migraine, other than these three agents have you tried anything else to help with acute migraines? For example how is your experience with Excedrin over the counter migraine treatment? How about Aleve or Naproxen which also comes as over the counter? Aleve or Naproxen comes in combination with Imitrex too and it is called as Treximet, have you had a chance to use it?

2) Are you on any migraine preventing agents, have you ever used migraine preventive agents so far?

3) Have you tried to identify migraine triggers, any success so far?

Kindly reply

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Customer reply replied 5 months ago
Over the counter nsaids and Tylenol are totally ineffective. I am currently taking topomax 300mg daily, and I have experienced migraines since puberty and have narrowed down my triggers and I avoid them as well as possible

Okay I see. I appreciate for all these additional information. I am preparing & typing my answer now, and I will post my answer here as soon as it is ready. Typing may take few minutes and I will follow up with you and post my answer here the moment I finish with my typing.

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I am almost done with my typing; I will follow up with you at the earliest.

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Writing a detailed note, almost done, I will post my answer here very soon. Thanks for the waiting.

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Customer reply replied 5 months ago
No problem and thank you

You are very welcome!

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Okay I am ready; I am posting my answer here, and once again thanks for the waiting!

Please see both Cambia and Divaloproex sodium (also known by its brand name Depakote) can be used to manage migraines

However cambia is used for the treatment of acute attacks of migraine only

Whereas the divalproex is used for the treatment of prevention of future migraine attacks only

Although in your case cambia has helped you considerably and it has helped you even to get rid of your headaches so it is possible in your case cambia had helped you with some migraine preventive properties too - but this is very rare experience, and usually it is considered as an acute attack treatment for migraine, rather than as a preventive agent

So if you are planning of switching cambia (for any reason including insurance/cost reasons) then cambia should be replaced by another medication or treatment that can help in treating the acute attacks of migraine

Of course divalproex can be used too, but it will help you only when it acts as a preventive agent, means it will not help you right away for an acute attack of migraine, you need to take divalproex for some time, may be at least for a week or two before its therapeutic effect kicks in, then it can act as a migraine preventive agent and start benefitting you by in this way, but while taking divalproex if you experience acute attacks of migraine then you still need an agent to help with acute attacks, so if imitrex and fioricet etc are not helping as much as cambia used to help then you need to try some other acute attack treatment for these breakthrough acute attacks that may occur while on preventing agents such as divalproex etc

And I see you have been already on topamax at 300 mg but it is not helping you.

And the reason I asked earlier whether otc nsaids helped you or not it - not actually to recommend you some of them, most migraine patients have already tried many such otc so I thought you too must have had used otc nsaids, but the reason I was asking about otc nsaid such as aleve or naproxen etc because cambia contains diclofenac which is also another nsaid, so I wanted to find out the tremendous response you have enjoyed with diclofenac (cambia) was related to its chemical property alone, means whether it helped you because it is an nsaid, if so then the otc nsaid also should help you, but it sounds the otc nsaids did not help you so it does not appear cambia helped you just being an nsaid, and there must be certain additional ways cambia may have helped you so much

What I will do now is to try to provide you with a comprehensive list of various treatments that are available for the management of migraine, and if you see any of the below treatments you have already not tried then please consider trying some of these;

The treatment of migraine consists of 4 main approaches as mentioned below;

A) Treatment of the acute migraine headaches called as “Migraine abortive treatments”

B) “Migraine preventive treatments” – which are used to prevent the future migraine attacks

C) Treatment of other symptoms associated with the migraine like nausea or vomiting etc (applicable if these symptoms are occurring with the migraine, not otherwise)

D) Management of migraine triggers etc

I have discussed each of the above approaches in more details below here;

A) Treatment of acute migraine headache attacks;

1) Trying certain General measures OR Home remedies OR OTC/Over the counter non-prescription treatments for acute migraine attacks such as the following;

Heat or Cold therapy (Hot compress or Cold compress)

Epsom salt compress

Epsom salt bath

Application of pain relieving creams such as Myoflex or Biofreeze

Application or rubbing with Essential oils such as Eucalyptus oil or Lavender oil

Aromatherapy with Essential oils such as Eucalyptus oil or Lavender oil

Head, neck, shoulder massage etc

Over the counter pain medications such as (you may tried some or all of these);

Naproxen

Excedrine migraine

Feverfew

Ginger preparations

Gelstat Sublingual

MigraSpray Sublingual spray etc

2) Trying certain Prescription medication options for acute migraine attacks such as the following;

Stronger anti-inflammatory pain killers such as Diclofenac (Cambia) – you have already tried, Tramadol

Triptan agents such as Imitrex (you have already tried), Rizatriptan, Naratriptan, Frovatriptan etc (they come in various forms including oral tablets, nasal sprays, skin patches & self- home injections etc)

Triptan agent + Anti-inflammatory pain killer combination like Tab Treximet

Midrin (this is arranged through compounding pharmacies)

Ergotamine preparations such as Ergomar Sublingual, Cafergot oral, Ergotamine suppositories, Ergotamine nasal spray, Ergotamine injection (can be self-injected at home) etc

Prochlorperazine (Oral, Suppositories, Liquid, Injections etc)

Intranasal Lidocaine 4%

Fiorinal or Fioricet – you have tried

Fiorinal with Codeine or Fioricet with Codeine

Butorphanol (Stadol) nasal spray

Narcotic/opioid drugs like Tylenol #3, Percocet, Lortab

Soma compound with codeine (a combination pill of three different medications together and contains Soma a muscle relaxant Aspirin an anti-inflammatory pain killer and Codeine a narcotic (opioid) pain killer)

A course of oral steroids etc

3) Trying certain Medical Device or Special Procedure treatment options for acute migraine attacks such as the following;

Spring TMS (Transcranial Magnetic Stimulator)

SPG Block (Sphenopalatine ganglion block) with Lidocaine 4% with or without a steroid

GammaCore non-invasive vagus nerve stimulation device

B) Treatment to help in preventing the future migraine (migraine headache preventive agents);

1) Trying certain General measures OR Home remedies OR OTC/Over the counter Non-prescription treatments for preventing future migraine attacks such as the following;

Identifying and avoiding exposure to migraine triggers as much as possible (stress, lack of sleep, caffeine, certain food triggers etc) – you have already tried migraine trigger management

Dietary modifications such as consuming magnesium rich diet consisting of green leafy vegetables, legumes, seeds, unrefined whole grains and brown rice, vegetable such as sweet potatoes, artichoke and okra, fruits such as apricots, kiwi fruit, yogurt and milk etc

Oral Magnesium supplements

Butturbur

Feverfew

Riboflavin (Vitamin B2)

CoQ 10 (Coenzyme q10)

Preventa Migraine

Migrelief

Migra spray or MigraSpray (can be used against for both acute attacks as well as to prevent future attacks)

Migralex

Migraclear

Migravent

Neuroline etc

2) Trying certain Prescription medication or injection treatment options for migraine prevention such as the following;

Beta blockers such as Propranolol, Metoprolol, Atenolol

Anticonvulsants such as Topamax (you are on it now), Depakote (you have inquired about this medication, this is the same as divaloproex sodium), Keppra, Zonisamide, Gabapentin, Pregabalin

GABA derivatives such as Baclofen, Tizanidine

Tricyclic medications such as Amitriptyline, Nortriptyline

Calcium Channel Blockers such as Verapamil, Diltiazem

Cyproheptadine

Botox injections

Steroid injection

SSRI agents such as Fluoxetine, Sertraline etc

3) Trying certain Complementary & Alternative medicine treatments to help with preventing migraine headaches such as the following;

Acupuncture

Biofeedback

Hypnotherapy etc

4) Trying certain Medical Devices or Special Procedures to help with preventing migraine headaches;

Trigeminal nerve Neurostimulation with Cefaly

TENS (Transcutaneous Electric Nerve Stimulation)

Occipital nerve block

Occipital Nerve Stimulation

SPG Block (Sphenopalatine ganglion block) with Lidocaine 4% with or without a steroid

Low Level Laser therapy (Cold Laser therapy) etc

C) If migraine attacks are associated with additional symptoms like nausea and/or vomiting then the following agents may help (only if experience nausea or vomiting, otherwise not needed);

Prochlorperazine

Promethazine

Metoclopramide etc

The above are the various treatment options to consider, but please see not all these above mentioned treatments may be required in your case; I am trying to provide a list of the various treatment options like this so that you are familiar with several treatments that are available for helping with your health condition and you may try to use them as necessary. If you see any of the above treatments you have already tried please disregard them and you may explore the treatment options which you may have not yet tried. I am sure you have tried many of the above preparations already, and if you see any of the above options you have not yet tried then please consider trying them to help you.

Once again to your main question, please see, divalproex is generally not considered as a substitute for cambia for the reason mentioned above, one is used for acute attacks and the other is used for prevention, since cambia helped you one option to consider is trying Treximet since it also contains an nsaid such as aleve along with imitrex, but it is not known whether you responded to cambia because it is nsaid or for some other reason since you did not respond to otc nsaids, but it is something to consider since it is a prescription preparation of aleve along with imitrex so it is something to consider, other than trying treximet if you see any other treatment options mentioned above you have still not used then these could be some additional options too to consider to help you with these unfortunate migraine headaches.

Wishing you a quick & complete recovery! And also Wishing you the best health!

All the very best!

Please let me know if you have any additional questions or if you want to discuss this further.

Assuring you the best services!

Best Regards!

Dr Subbanna MD

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Customer reply replied 5 months ago
Thank you very much Dr. Subbanna. I appreciate your thorough explanation and discussion of different courses of treatment.

You are very welcome! My pleasure! I am very glad you found the above information helpful!

I earnestly hope you will find the above information & the list and course of treatments very helpful to you!

Please let me know if you have any additional questions or if you want to discuss this further. And please take a moment and kindly click a positive rating (preferably 5 Star/Excellent) to credit for the time & effort put by me in answering your health question, and this is the only way I will be credited for my service to you. Rating me now does not close your question and if you have follow-up or additional questions you can ask them after the rating too!

Assuring you the best services!

Wishing you all the very best!

Best Regards!

Dr Subbanna MD

Dr Subbanna MD
Dr Subbanna MD, Neurologist (MD)
Category: Neurology
Satisfied Customers: 6,422
Experience: American Board Certified Neurologist, Internal Medicine
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