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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