Depakote and Blood Tests

[lisa2712]

Hi,

Does anyone taking Depakote go for a 3-month blood test, specifically to test the Depakote levels in your blood? I took Depakote about 6 years ago and I don't remember ever having to take a blood test to measure the Depakote levels in my blood. I remember being extremely tired on Depakote, to where I couldn't stay awake during the day even after a full night's sleep, and even after drinking caffeine. However, I go to a different psychiatrist now, and she told me on Depakote I would need to have my blood tested every 3 months to measure the Depakote level in my body. I was thinking that maybe I was so extremely tired on Depakote years ago was because I may have had too much of it in my body, because I didn't get any blood tests done for Depakote levels. 

[Iceberg]

8 minutes ago, lisa2712 said:

Hi,

Does anyone taking Depakote go for a 3-month blood test, specifically to test the Depakote levels in your blood? I took Depakote about 6 years ago and I don't remember ever having to take a blood test to measure the Depakote levels in my blood. I remember being extremely tired on Depakote, to where I couldn't stay awake during the day even after a full night's sleep, and even after drinking caffeine. However, I go to a different psychiatrist now, and she told me on Depakote I would need to have my blood tested every 3 months to measure the Depakote level in my body. I was thinking that maybe I was so extremely tired on Depakote years ago was because I may have had too much of it in my body, because I didn't get any blood tests done for Depakote levels. 

Yea that's very possible that it was too high. I also was told to do semi regular Bloodwork 

[notloki]

The PI specifies required blood tests, mainly they are measuring your liver function as Depakote can be hard on the liver. Standard practice requires the blood tests. Fortunately you can get a therapeutic blood level as it is easy to go toxic if you don't check it. Most drugs do not have this feature but the anticonvulsants tend to have this test available.

[notloki]

3 minutes ago, notloki said:

The PI specifies required blood tests, mainly they are measuring your liver function as Depakote can be hard on the liver. Standard practice requires the blood tests. Fortunately you can get a therapeutic blood level as it is easy to go toxic if you don't check it. Most drugs do not have this feature but the anticonvulsants tend to have this test available.

I looked at the PI, it has a black box warning for the blood tests:

WARNING: LIFE THREATENING ADVERSE REACTIONS See full prescribing information for complete boxed warning. • Hepatotoxicity, including fatalities, usually during the first 6 months of treatment. Children under the age of two years and patients with mitochondrial disorders are at higher risk. Monitor patients closely, and perform serum liver testing prior to therapy and at frequent intervals thereafter (5.1) • Fetal Risk, particularly neural tube defects, other major malformations, and decreased IQ (5.2, 5.3, 5.4) • Pancreatitis, including fatal hemorrhagic cases (5.5)

[lisa2712]

14 hours ago, notloki said:

The PI specifies required blood tests, mainly they are measuring your liver function as Depakote can be hard on the liver. Standard practice requires the blood tests. Fortunately you can get a therapeutic blood level as it is easy to go toxic if you don't check it. Most drugs do not have this feature but the anticonvulsants tend to have this test available.



I already have high liver enzymes. I was just curious if my extreme fatigue and tiredness on Depakote was caused by having too much of it in my blood, because I don't remember going for blood tests on Depakote, but I did have to on Tegretol. 

[browri]

Yeah the fact that they didn't do any blood monitoring for you the last time you were on Depakote is a bit strange. Measuring the blood level is one thing, but they also have to monitor white blood cell count and liver function. Important to note that if you already have elevated liver enzymes, you should have a CMP (comprehensive metabolic panel) and a WBC (white blood cell count) done before starting Depakote. Then after you've been taking it for about 2 weeks at a consistent dose get those tests done again along with the valproic acid level.

Valproate can definitely make you tired, and it is dosed by weight because weight can greatly affect accumulation. Talking to someone else, they were able to achieve above 50mcg/mL with just 500mg of the Depakote ER, but it took me until ~1000-1250mg before I actually got over that hump. I'm 6' and 200lbs versus this other person who was more petite. That being said, my pdoc considers 1000mg to be the "average dose". He let me know that typically for inpatient acute mania or hypomania, they want to achieve levels of 80-100mcg/mL. The 50-100 range that is typically referenced on blood tests is the range for epilepsy. However, for sub-acute bipolar treatment (fully outpatient but presenting somewhat acutely with (hypo)manic symptoms), they would shoot for 50 or so. I was maintaining quite well even below 50. So don't read into the level too much. Outside of the emergency room, they typically dose based on response and tolerability.

Keep an eye out for irritability too when you start. I see from your profile that you are female, and Depakote can be problematic for some in the female population because it is androgenic, meaning it may slightly elevate testosterone levels. Because the body converts testosterone into estrogen when it is broken down, this may manifest as PMS-style irritability. Fun quick fact that this is also where "roid rage" comes from. Guys inject testosterone and everyone thinks it's the high testosterone that's making them ragey, when most people don't realize it's what happens AFTER the body breaks the testosterone down into estrogen that makes them rage out. Random, I apologize. lol 

Edited January 9, 2019 by browri
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