A pilot study of loading versus titration of valproate in the treatment of acute mania

Abstract

This suggests that a loading dose of valproate is likely safe and may provide an earlier onset of antimanic effects in patients with bipolar disorder. Future studies with larger sample sizes are indicated.

Oral Loading of Sodium Valproate Compared to Intravenous Loading and Oral Maintenance in Acutely Manic Bipolar Patients

“…We also noted, however, that this latter was still more rapid than the time lag reported by Hirschfeld et al [7] for a nonloading condition, and as quick as observed in the loading condition reported by Oluboka et al [6]. …”

“…We would like to point out additionally that, compared to previous research [6,7,9,16], the therapeutically significant level of serum SV of at least 50 mg/ml had already been achieved in the loading condition after the first day of treatment, whereas in the maintenance condition this level was only reached after 3 days of treatment. We also noted, however, that this latter was still more rapid than the time lag reported by Hirschfeld et al [7] for a nonloading condition, and as quick as observed in the loading condition reported by Oluboka et al [6].…”

“…However, between 20 and 40% of treated patients appear to be insufficiently responsive to this treatment. In the last 15 years, sodium valproate (SV) proved to be effective for both acute mania [6,7,8,9] and acute bipolar depression [10,11]. SV is the sodium salt of valproic acid.…”

“…Several studies have shown that, in treating the acute phase of mania and achieving a quick and safe response to the psychopharmacologic treatment, symptom reduction is associated with the rapid achievement of therapeutic blood levels of SV [6,15], and Bowden et al [9] have shown that trough serum levels of SV above 50 mg/ml indicated therapeutic efficacy in the treatment of acute mania. A trough serum level of SV above 50 mg/ml has been obtained 5-10 days after treatment began [9,16], but has also been apparent after the first 3 days of treatment with oral loading, as compared to the titration condition [6].…”

“…A trough serum level of SV above 50 mg/ml has been obtained 5-10 days after treatment began [9,16], but has also been apparent after the first 3 days of treatment with oral loading, as compared to the titration condition [6]. …”