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Just now, esmereldaskysurfer said:

I asked my NP about starting Vraylar, and he said he is not happy with that idea and instead is starting me on low-dose Valproic Acid.

Am i going to gain a fuck ton of weight like i would on Depakote?

Basically is Depakote. Have you been on it before and gained weight? What symptoms are you targeting? 

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Never been on it before as it is a known gainer and im still trying to lose the weight i gained on Clozaril.

Targeting mania, specifically, with the end goal being getting me on the high end of normal. He does not want to increase my Lithium any more because when i go higher than 900mg i start feeling dead inside and stop taking my meds.

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23 minutes ago, esmereldaskysurfer said:

Never been on it before as it is a known gainer and im still trying to lose the weight i gained on Clozaril.

Targeting mania, specifically, with the end goal being getting me on the high end of normal. He does not want to increase my Lithium any more because when i go higher than 900mg i start feeling dead inside and stop taking my meds.

Then I see the docs point- While Vraylar is approved for acute mania, I think Depakote is more tried and true for fast antimanic response

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  • 2 weeks later...

You can create a category for valproate. In its free form, it's known as valproic acid. The brands for this are Stavzor and Depakene. Typically this is only used for epilepsy, but some pdocs still use it for bipolar disorder. When valproic acid is not free form, it is bonded to sodium and called sodium valproate. Medications that are 100% sodium valproate are only used outside of the U.S. In British countries, it is often referred to as Epilim. Finally, the most modern form of valproate is known as divalproex sodium or valproate semisodium. Two different names that mean the same thing. These are branded Depakote. With these, the pills are a fixed ratio of free base valproic acid mixed with bonded sodium valproate. Supposedly this improves the pharmacokinetics to reduce side effects and improve efficacy.

Valproate CAN cause weight gain, but that doesn't mean it WILL. I fluctuate around 180-200 lbs. Depakote hasn't changed the range at all, but I may spend more time on the upper end of my weight range. In my experience too, the weight gain on Depakote is dose proportionate. So a low dose of it may have no effect on weight at all.

@Iceberg would be correct that valproate will stabilize more quickly, and you can titrate up faster with a wider dose range (anywhere from 250mg to 2000mg or more). Its half-life isn't that long so the time it takes to build in the system is less, allowing for a much quicker response. Vraylar on the other hand has a pretty tight dose scale, and because of the long half-life and thus the long time it takes to reach steady state plasma levels, it's easy to overshoot the dose and have to reduce it later because of side effects. Meaning it can take sometimes more than 2-4 weeks for side effects to become apparent on Vraylar, whereas on Depakote they're apparent within a few days. Just the same, Vraylar may show improvement in symptoms after a few days, but full stabilization is oftentimes not evident for several weeks. Pdocs like to stabilize in emergent situations with valproate or lithium and then transition to something else like Vraylar after stabilization has been reached.

Your pdoc also may also be concerned about Vraylar's higher propensity for akathisia and other EPS / movement-related side effects.

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  • 5 weeks later...
9 hours ago, mjs190 said:

Yeah, thats essentially the same thing as Depakote. I take 1,000 mg at night, down from 1,500, and I haven't gained any weight. At higher blood levels, like ~100, I gained a few pounds.

Holy cow, you take 1000mg of Depakote but VPA still clocks in at 81 ug/mL ? Or is that level from when you were at 1500mg of Depakote? I mean I take 1000mg and I only generally get a level in the high 30s to mid 40s.

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18 hours ago, browri said:

Holy cow, you take 1000mg of Depakote but VPA still clocks in at 81 ug/mL ? Or is that level from when you were at 1500mg of Depakote? I mean I take 1000mg and I only generally get a level in the high 30s to mid 40s.

Yeah, I take 1,000 mg for 80.9 mcg/ml haha. I guess I absorb it well?

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17 hours ago, morpheus said:

My recent labs on valproate:

 

1500mg Divalproex sodium - (trough level?) 61mcg/ml

1500mg valproic acid - (trough level) - 52 mcg/ml

That doesn't surprise me. Valproic acid free base is 100% immediate release whereas divalproex is partially sodium-bound thus improving pharmacokinetics and extending half-life.

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