Dr. Bob's Psychopharmacology Tips

Starting dose of divalproex

From: MHeaney831@aol.com
Date: Wed, 1 May 1996 11:48:36 -0400
Subject: Starting dose of divalproex

I use a starting dose of divalproex (Depakote) for mania of 20 mg/kg, up to 1200 mg.

Date: Wed, 01 May 96 18:12:25 PST
From: William Wilson <wilsonw@ohsu.edu>
Subject: Starting dose of divalproex

We use 20 mg/kg Depakote in an inpatient setting without any problems.

Date: Tue, 13 Aug 1996 22:16:10 -0700 (PDT)
From: ckuttner@proaxis.com (Charles Kuttner)
Subject: Starting dose of divalproex

Handy-dandy tip (from a Depakote salesperson): an easy formula for us docs living in the US, where the metric system apparently will never catch on, is to take the patient's weight in pounds, then add a zero, to yield a dose in mg. For example, a person who weighs 150 pounds should take about 1500 mg/day.

From: cprice@mem.po.com (Charles Sowle Price, MD)
Date: Fri, 16 Aug 1996 01:02:42 -0400
Subject: Starting dose of divalproex

Actually I just take the weight in pounds, add a zero, and round to the closest 250 or 500. Example: today I prescribed for a 135-lb. female. I figured 1350 mg and rounded to 1500 mg. I always check a level in 4-5 days to be sure the metabolism is normal.

Date: Sat, 24 May 1997 19:24:24 +1200
From: Felicity Plunkett <felicity@iprolink.co.nz>
Subject: Starting dose of valproate

I did this summary recently for our local Journal Club, as doctors here are a bit behind the US regarding use of valproate:

Practical Points Regarding Use of Valproate

In acute mania & mixed affective states:

• You can get desired serum levels in 48 hrs by charting 20 mg/kg (eg, for a 75 kg person, 1500 mg/day = 500 mg tid) straight off. You don't need to titrate up to this dose. If you start this fast, be sure to know the serum level on day 5.

• Because USA doctors tend to titrate lithium up more slowly to 1.0-ish serum levels, they say acute therapy with valproate is faster, so lengths of stay are shorter! Expect some response to valproate, used as above, in 5 days.

In long-term prophylaxis:

• When not urgent, start at 10 mg/kg, then titrate up or down according to the serum level on day 5. It may take 2 weeks to achieve desired serum levels.

From: cprice@mem.po.com (Charles Sowle Price, MD)
Date: Sat, 24 May 1997 10:53:13 -0400
Subject: Starting dose of valproate

This should get blood levels within the seizure treatment range in 2-3 days. If the patient is having manic insomnia, I will start with the whole dose at night to use the sedative side effect to advantage.

A reference is:

Keck PE Jr, McElroy SL, Tugrul KC, Bennett JA. Valproate oral loading in the treatment of acute mania. Journal of Clinical Psychiatry. 54 (8): 305-8, 1993 Aug.

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