Depakote (Valproate) and Hair Loss: How Common It Is and What to Record

Yes. Hair loss is one of the most common side effects of Depakote (divalproex) and other forms of valproate. The Depakote label lists alopecia among its most common adverse reactions, and a 2019 meta-analysis put the overall rate at about 11 percent. The label also reports changes in hair texture and colour. It is a known effect, so it is worth raising with your prescriber rather than putting up with in silence.

Valproate treats epilepsy, bipolar disorder and migraine, and stopping it suddenly can be dangerous. The answer is never to stop on your own; it is to bring a clear record to the person who prescribes it.

What the label says

The Depakote prescribing information lists alopecia among the most common adverse reactions across its uses. In a placebo-controlled trial of add-on treatment for complex partial seizures, 6 percent on Depakote reported hair loss against 1 percent on placebo. In a trial comparing two doses on their own, it was reported by 24 percent on the higher dose and 13 percent on the lower one. In migraine trials, it was 7 percent against 1 percent, and hair loss was the most common reason people gave for stopping in the longer migraine study, at 6 percent (Depakote label on DailyMed).

Among reports after approval, the label adds hair texture changes and hair colour changes. MedlinePlus lists hair loss among the side effects to tell your doctor about if it is severe or does not go away (MedlinePlus: valproic acid).

What the research adds

A 2019 systematic review and meta-analysis pooled 25 prospective studies. About 11 percent of people on valproate had hair loss, and the risk was several times higher than with other drugs, in both epilepsy and migraine. The authors found raised risk at lower and higher doses and over shorter and longer courses, and concluded that the risk did not depend on dose or treatment time (Wang and colleagues, 2019).

That last finding differs from the label's higher-dose trial, which saw more hair loss at the higher dose. The two can both be true: one trial compared doses directly, while the meta-analysis compared valproate with other drugs across many studies. Either way, hair loss on valproate is common enough that your prescriber will have seen it before.

What is not known

• Exactly why valproate causes hair loss. The sources above do not settle the mechanism.
• Who will be affected. Nothing in the label or the meta-analysis predicts it for one person.
• How reliably supplements help. Online advice often suggests them, but the sources above do not test them.

What to record

• Dates: when you started, every change your prescriber made, and any switch between forms.
• Shedding notes: on wash days, a rough count or the same few words for what you see.
• Photos: hairline, temples, crown and part in the same light. See how often to take progress photos.
• Texture and colour: note if your hair turns curlier, straighter, finer or a different shade, since the label lists these too.
• Other triggers: weight change, illness or stress, which can cause shedding on their own. See telogen effluvium vs male pattern baldness.

Talking to your prescriber

MedlinePlus warns not to stop taking valproic acid without talking to your doctor, because stopping suddenly can bring on seizures (MedlinePlus: valproic acid). Bring your dates and photos, and ask whether the hair loss changes the plan. Any change in dose or medicine is the prescriber's decision.

Related reading

• Does Adderall cause hair loss?
• Does Accutane cause hair loss?
• How to track hair loss

Sources: Depakote prescribing information, DailyMed; MedlinePlus: valproic acid; Wang et al. 2019, Seizure.