How to Switch Between Valproate Formulations?

Valproate is an FDA approved treatment for bipolar disorder. According to CANMAT and ISBD (2018 guidelines) valproate is indicated for the following phases of bipolar disorder:

Acute manic episodes: as First line
Bipolar 1 depression: as Second line
Bipolar Maintenance Treatment: as First line
Bipolar 2 disorder: as Third line

Valproate is available in following different formulations:

Valproic acid liquid.
Divalproex sodium sprinkle capsules.
Divalproex sodium delayed-release tablets.
Divalproex sodium enteric-coated tablets.
Divalproex sodium ER (Extended Release).

HOW TO SWITCH BETWEEN THESE AVAILABLE VALPROATE FORMULATIONS?

Answer: Increase the total daily dose by 250 to 500 mg

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This chapter will be summarized in following sections:

Depakote dose equivalences & Tmax.
Dosing recommendation for depakote.
How to switch patients from delayed-release TO extended-release divalproex?
Therapeutic level for depakote.
Calculating depakote level in patients with low albumin level.

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