5 $

DEPAKOTE SAVINGS PROGRAM
Pay as little as
5
$
BILL PRIMARY INSURANCE FIRST
INSURED PATIENTS ONLY
RxBIN:
601341
RxPCN:
OHCP
OH9001121
RxGrp:
RxID:
436100100838
Suf:
01
per
month*
*Up to $75 off for eligible insured patients.
See brochure for Important Safety Information, including
warnings for risk of liver problems, pancreas problems,
and birth defects. See full Prescribing Information in pocket.
Use this card every time you
fill your Depakote prescription.
Start Saving Today.*
* See eligibility restrictions below.
STEP 1
STEP 2
✓
Take this printout with your prescription for Depakote, Depakote ER, or Depakote Sprinkle Capsules
to your pharmacist and start saving immediately!
Present this printed Co-Pay Card every time you fill a Depakote, Depakote ER, or Depakote Sprinkle
Capsules prescription for instant savings. This card can be used up to 2 times per month.
You pay the first $5 of your co-payment on qualified prescriptions, and the discount covers up to the
next $75 off of your remaining co-pay expenses. The card is valid at mail-order pharmacies, but they may
have different requirements. If needed, you can find a rebate form on Depakote.com.
When filling a prescription for Depakote, Depakote ER, or Depakote Sprinkle Capsules, make sure
your pills look like those shown below. If not, call your doctor or talk to your pharmacist.
Depakote 125 mg
✓
✓
Depakote 250 mg
Depakote 500 mg
Depakote ER 250 mg
Depakote ER 500 mg
Depakote Sprinkle Capsules 125 mg
Tablets and Capsule Shown Are Not Actual Size
Inform your pharmacist of your preference for the Depakote brand.
Check the label on your prescription bottle to be sure it says Depakote, Depakote ER, or
Depakote Sprinkle Capsules.
Patient Instructions:
Present this printable version of the Depakote, Depakote ER, or Depakote Sprinkle Capsules Co-Pay Card along with your insurance card when presenting your
prescription in order to receive discounts. You pay the first $5 of your co-payment on qualified prescriptions and the discount covers up to the next $75 off of your
remaining co-pay expenses. This printout is valid for up to 2 uses per month. This is also valid at mail-order pharmacies, yet they may have different requirements.
Please contact your mail-order pharmacist for redemption instructions.
Pharmacist Instructions:
Please submit the co-pay authorized by the patient’s primary insurance as a secondary transaction
to OPUS Health. If you have questions, please call OPUS Health at: 1-800-364-4767.
This offer may be changed or discontinued without notice.
*Eligibility Restrictions:
This downloadable discount is the property of AbbVie Inc. and must be surrendered upon demand. This is not valid
for persons eligible for reimbursement of this product, in whole or in part, under Medicare, Medicaid or
similar federal or state programs or in Massachusetts. Offer void where prohibited by law.
Please read Uses and Important Safety Information, including risks of
liver problems, pancreas problems, and birth defects on the next page.
Full Prescribing Information available at
http://www.Depakote.com/prescribing-information
What is Depakote used for?
Other serious side effects from taking Depakote:
Depakote comes in different dosage forms. Depakote® (divalproex sodium)
Tablets for Oral use and Depakote® ER (divalproex sodium) Tablet,
Extended Release for Oral use are prescription medications used:
• To treat acute manic episodes associated with bipolar disorder
• Alone or with other medications to treat:
– Complex partial seizures in adults and children 10 years of age and older
– Simple and complex absence seizures, with or without other
seizure types
• Low blood platelet counts
• High blood ammonia levels
• Hypothermia (body temperature less than 95º F)
• Allergic reactions
• Extreme drowsiness in some elderly patients. Causing less than normal
eating or drinking
• To prevent migraine headaches
Depakote® Sprinkle Capsules (divalproex sodium coated particles in
capsules), for oral use is a prescription medicine used alone or with other
medicines to treat:
• Complex partial seizures in adults and children 10 years of age and older
• Simple and complex absence seizures, with or without other seizure types
Important Safety Information
The most important information about Depakote:
Do not stop taking Depakote without first talking to your doctor.
Stopping Depakote suddenly can cause serious problems.
Depakote can cause SERIOUS SIDE EFFECTS, including:
• Serious liver damage that can cause death, especially in children
younger than 2 years old. The risk of getting serious liver damage is
more likely within the first 6 months of treatment. Liver damage may
continue despite stopping the drug. Call your doctor right away if you
develop any of these symptoms: nausea or vomiting that doesn’t go
away, loss of appetite, pain on the right side of your stomach, dark
urine, swelling of your face, or yellowing of your skin or whites of
your eyes.
• Depakote may harm your unborn baby. Taking Depakote during
pregnancy puts your baby at risk for serious birth defects. The most
common birth defects affect the brain and spinal cord, called spina
bifida or neural tube defects, and occur in 1 to 2 out of every 100
babies born to mothers who use Depakote during pregnancy. These
defects can begin in the first month, before you know you are
pregnant. Other birth defects can also happen. If you take Depakote
while you are pregnant, your child is at risk for having a lower IQ.
Women who are pregnant must not take Depakote to prevent migraine
headaches. All women of childbearing age should talk to their doctor
about using other treatments instead of Depakote. There may be other
medicines to treat your condition that have a lower chance of causing
birth defects and decreased IQ in your child. If you use Depakote, use
effective birth control. Tell your healthcare provider right away if you
become pregnant while taking Depakote. Taking folic acid
supplements before getting pregnant and during early pregnancy can
lower the chance of having a baby with neural tube defects.
• Inflammation of your pancreas that can cause death. Call your doctor
right away if you develop severe stomach pain that you may also feel
in your back, or nausea or vomiting that does not go away.
• Depakote may cause suicidal thoughts and actions in a very small
number of people, about 1 in 500. Be alert for any sudden changes in
mood, behaviors, thoughts or feelings. Call your doctor right away if you
have any of these symptoms, especially if they are new or worsen:
thoughts of suicide or dying; attempting suicide; new or worse depression,
anxiety or irritability; feeling agitated or restless, angry, aggressive, or
violent; panic attacks; trouble sleeping; acting on dangerous impulses; or
extreme increase in talking or activity.
DO NOT TAKE Depakote if you:
• Have liver problems
• Have or think you have a genetic liver problem caused by a mitochondrial
disorder (e.g., Alpers-Huttenlocher syndrome)
• Are allergic to the ingredients
• Have a genetic condition called urea cycle disorder, causing too much
ammonia to build up in your body
• DO NOT TAKE Depakote for the prevention of migraine headaches if
you are pregnant
BEFORE starting Depakote, tell your healthcare provider if you:
• Have liver disease
• Have a genetic liver problem caused by a mitochondrial disorder (e.g.,
Alpers-Huttenlocher syndrome)
• Are pregnant, planning to become pregnant, or breastfeeding
• Drink alcohol
• Have depression, mood problems, or suicidal thoughts or behavior
• Have a colostomy, ileostomy, or gastrointestinal disorder
• Have any other medical condition
• Take any medicines, including those with and without a prescription,
vitamins, and herbal supplements and medicines
©2013 AbbVie Inc. North Chicago, IL 60064 809685-836411 June 2013
Tell your healthcare provider right away if you develop:
• Red or purple spots on your skin
• Bruising
• Bleeding from your mouth, teeth, or nose
• Abnormal drowsiness, a feeling of being more tired or drowsy than usual
• Vomiting
• Confusion, difficulty thinking, or difficulty staying awake or waking up
• An inability to eat or drink as you normally do, a loss of appetite or not
wanting to eat or drink as you normally do
• Call your doctor immediately if you become pregnant or think you are
pregnant. If you want to become pregnant, let your doctor know before
you begin trying
• Tell your doctor if you notice the shell of the Depakote tablet or capsule in
your stool
Or if you develop signs of an allergic reaction including the following:
1. Fever
5. Sores in mouth
2. Skin rash
6. Swelling of lymph nodes, face,
3. Hives
eyes, lips, tongue, or throat
4. Blisters
7. Trouble swallowing or breathing
Some common side effects of Depakote:
• Nausea
• Headache
• Sleepiness
• Tremor
• Dizziness
• Weakness
• Hair loss
• Diarrhea
• Vomiting
• Weight gain
• Blurry vision
• Loss of appetite
• Increased appetite
• Coordination problems
• Walking problems
• Stomach pain
• Double vision
References:
1. Depakote [package insert].
2. Depakote ER [package insert].
3. Depakote Sprinkle Capsules [package insert].
You are encouraged to report negative side effects of prescription drugs to
the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.
If you cannot afford your medication, contact www.pparx.org or call the
toll-free phone number (1-888-4PPA-NOW) for assistance.