someone explain to me how depakote dosing works

[Yuna]

What mg translate to the blood level thing, also what is the slowest and best way to titrate? I am medication sensitive so I want to titrate slow. Thinking of doing the ER pills.. they only come in 250 and 500mg It looks like.

 

Any advice would be nice. 

 

About had enough of this Trileptal experiment. 

[jt07]

No one can tell you the correct dose of Depakote because we all metabolize meds differently. One person might find 1000 mg sufficient to be in the therapeutic zone while another might need 1500 mg. It's like lithium and is dosed based on blood level.

Edit: Are you working with a psychiatrist?

Edited April 9, 2017 by jt07

[Yuna]

2 hours ago, jt07 said:

No one can tell you the correct dose of Depakote because we all metabolize meds differently. One person might find 1000 mg sufficient to be in the therapeutic zone while another might need 1500 mg. It's like lithium and is dosed based on blood level.

Edit: Are you working with a psychiatrist?

Yes but he is an asshole who doesn't care. So if I change my current med I'd like to start the next med at a small doseage since I'm sensitive , not the whole goddamn stack. So I'd like to familiarize myself with doseages before hand. 

[notloki]

Yes you can start it low and build up. Generally that is the way you start Depakote. You really need to blood test to determine the correct maintenance dose, as others have said. Generally people seem to take the ER formulation the most, easier on the tummy. Depakote ER is made in 250 and 500 mg tabs in the US. So maybe ask to start at 250 mg Depakote ER. There is a 125, 250, and 500 mg tab that is not ER but still delayed release. The ER is extended delayed release.

Edited April 9, 2017 by notloki

[Yuna]

1 hour ago, notloki said:

Yes you can start it low and build up. Generally that is the way you start Depakote. You really need to blood test to determine the correct maintenance dose, as others have said. Generally people seem to take the ER formulation the most, easier on the tummy. Depakote ER is made in 250 and 500 mg tabs in the US. So maybe ask to start at 250 mg Depakote ER. There is a 125, 250, and 500 mg tab that is not ER but still delayed release. The ER is extended delayed release.

When you say "delayed release" does that simply mean its a normal pill? How is the ER different?

Does the ER version work better for bipolar? 

[getouttamyway.exe]

The ER or CR make it so you body releases a constant amount throughout the day, which helps a lot with side effects, and can help with your moods. I take Lithium CR and with that I really don't notice the side effects. you dont get that big burst of meds and then nothing until the next dose.

[MiaB]

 Moving to anticonvulsant board.

[notloki]

The regular pill is listed in the literature as delayed release. The pill you want is Depakote ER for extended delayed release. It will do a better job at releasing a regular, even dose of Depakote throughout the day than the regular pill.

[Iceberg]

...and probably with less stress on the gastrointestinal system...Depakote can be hard on the stomach esp on the non ER form 

[confused]

I think your weight has some effect on the therapeutic dose. When I gained weight my dosage went up. ymmv

[mjs190]

I take 500 mg of Depakote ER and my blood level is ~43 µg/mL which is quite high for such a low mg dose. When I was at 1,000 mg, my blood level was roughly ~61 µg/mL, so for me personally, I have an idea of what dosage will yield a certain blood level. But this is different for everyone, as not everyone's livers will process the medication with eh same speed or efficiency. At the end of the day, the mg dosage doesn't matter; you're most concerned with the blood level. And ideally, that blood level falls somewhere between 50-100 µg/mL.

[notloki]

5 hours ago, confused said:

I think your weight has some effect on the therapeutic dose. When I gained weight my dosage went up. ymmv

Yes. The range for bipolar is 25-60 mg/kg. Still serum levels are the ultimate determiner of the dosage taken but bigger people generally take more depakote.

[Wacko]

all is according with the  levels of  depakote (valproic acid ]) on  bloodstream, the dose always start with 1000 and from there   can do adjustments if the bloodstream  levels are under  of the   good levels, everything higher of 70s in the bloodstream appears the minimum and maximums  of that level and well your  psychiatrist may want up the dose till 1.500mg that is the highest , i been in that medication since 2009 and been like ok to me

[Iceberg]

What? You just said its all blood level then listed a max dose 

[notloki]

Lots of drugs have a mg/kg range. Very few drugs have tests for levels in  the body, except the antiepileptics. 

[jacques]

I take the standard DR and find it fairly okay. I also haven't had any stomach problems with it and I haven't noticed any side effects.

As far as the starting low and building up, you can.  That's actually what they plan to do with me once I get my depakote levels done again, due to the fact that my old prescribing doctor didn't tell me that I wasn't supposed to take my morning dose until after my blood test.

[JustNuts]

It is impossible to tell you what dose will translate to a specific blood level. The therapeutic range for blood levels is "commonly considered to be" 50-100 mcg/mL.

Divalproex sodium is available in 125mg "sprinkle" capsules, 125mg/250mg/500mg delayed-release capsules, and 250mg/500mg extended-release capsules. The DR capsules are normally dosed TID. The ER capsules are normally dosed QD and were intended for use in migraine suffers specifically but can be used for other uses. Initial doses of DR/ER for mania are 750mg and 25mg/kg respectively, and the maximum dose for either form is 60mg/kg.

There is also valproate sodium and valproic acid. The first isn't used much. The second is available as 250mg capsules or 125mg/250mg/500mg delayed-release capsules, is indicated for mania/migraine only as far as I can tell, and seems less commonly used.

BTW this drug is pretty hard on your stomach, so take it with food. Also, the 250mg and especially 500mg pills are a bit ridiculously large and thus somewhat hard to swallow.

Sudden discontinuation of this drug is dangerous due to the risk of seizures and it must be titrated up and down somewhat slowly (although not as slow as stuff like lamotrigine).

Note that most of this information is from my hardcopy of the 2013 Nursing Drug Handbook (33rd edition), and thus the available forms information may be somewhat outdated.

[dtac]

I concur with it being hard on your stomach. Any dosage change (up or down) gave me GI upset for 4-5 days, even with the ER version.

From personal experience, I've had two different pdocs start me at 1000mg/day of the ER, wait a week to get a blood level, then titrate from there. I did go up to 1500mg/day, but I gained 6lbs in a week and my blood level was above therapeutic range, so we dropped it back to 1000mg/day. And yes, those ER tablets are pretty damn big -- I hated swallowing them.

If you really hate the tablets, you can look into Depakene (valproic acid in a liquid form). I took it once, and it wasn't too bad, but I'm not sure of the pharmacokinetics compared to the ER tablets.