Valproate as a Loading Treatment in Acute Mania

Abstract

Evidence from earlier studies indicates that the antimanic action of valproate becomes most apparent within 1-4 days of achieving serum concentrations 50 µg/ml, that valproate can be orally loaded with achievement of therapeutic serum concentrations within the first several days of treatment, there is a rapid onset of response, and minimal side effects. To provide further data on the safety and efficacy of valproate oral loading in the treatment of acute mania, we evaluated 13 consecutive patients with acute manic syndromes who received valproate initiated at a dosage of 20 mg/kg/day. In most cases, valproate was added to other psychotropics. All 13 patients received at least 5 full days of valproate maintained at or above 20 mg/kg/day, and valproate serum concentrations were 50 µg/ml (mean ± SD = 88 + 25) by the second or third day of treatment. Ten (77%) patients displayed a moderate or marked response. Side effects were infrequent and minor. Consistent with our earlier study, these findings suggest that valproate can be safely administered via a loading dose of 20 mg/kg/day to patients with acute mania, including those on other psychotropics, and that it may produce a rapid response with minimal side effects.

Valproate: Past, Present, and Future

“…Similar drug levels are recommended for patients with bipolar disorder (88). Because of the marked variability of serum levels over a 24 h period, blood samples should be drawn before the first dose of the day in order to ensure relative comparability of different determinations (66 (64).…”

“…Patients in a mixed-state and rapid cyclers seem to respond better to VPA or carbamazepine than to lithium, but well documented, double-blind randomized studies are still needed to evaluate the long-term effectiveness of either drug (16). In the acute manic state of patients with bipolar or schizoaffective disorders, VPA is effective as short-term treatment with a rapid onset of action (70,88). In these disorders, VPA seems to be more beneficial for patients with a seizure history or with abnormal neurological features (113).…”

Tolerability of Oral Loading of Divalproex Sodium in Child Psychiatry Inpatients

“…This is slightly lower than the 20 mg/kg/day generally used for oral loading in adults McElroy et al 1993McElroy et al , 1996 and was chosen for extra caution. The patients were divided into two groups based on the weight used to calculate the initial dosing regimen.…”

“…The mood stabilizing properties of valproate appear to lag days to weeks behind the achievement of therapeutic drug levels (Pope et al 1991). Studies of oral loading of divalproex in adults reveal that oral loading is a well-tolerated method to rapidly achieve therapeutic drug levels Martinez et al 1998;McElroy et al 1993McElroy et al , 1996. The goal of this study was to determine if 15 mg/kg/day is a well-tolerated oral load of divalproex sodium that quickly and reliably achieves therapeutic drug levels in child psychiatry inpatients.…”

Folate Screening Pattern at the Psychiatric Inpatient Unit at HMC, Qatar-Quality Improvement Project

“…The APA recommends maintaining serum valproate levels of 50 to 125 mcg/mL when treating: acutely manic patients, outpatients, the elderly and patients who are hypomanic or euthymic [3,[12][13][14][15].…”