(Q.2): Which of the following mood stabilizer will NOT need dosage adjustment in patient with eCrCl of 25 mL/min?
Answer: 2. Depakote.
A slight reduction (27%) in the unbound clearance of valproate has been reported in patients with renal failure (creatinine clearance < 10 mL/minute); however, hemodialysis typically reduces valproate concentrations by about 20%. Therefore, no dosage adjustment appears to be necessary in patients with renal failure.
Protein binding in these patients is substantially reduced; thus, monitoring total concentrations may be misleading.
In patients with creatinine clearance <30 mL/min: initiate at one-half the usual starting dose (300 mg/day, given twice-a-day) and increase slowly to achieve the desired clinical response.
Creatinine Clearance > 60 : 900 to 3600 mg/day.
Creatinine Clearance >30-59: 400- 1400 mg/day.
Creatinine Clearance >15-29: 200- 700 mg/day.
Creatinine Clearance <15: 100-300 mg/day.
In renally impaired patients (creatinine clearance less than 70), one-half of the adult dose is recommended.
Mild to moderate renal impairment (CLcr 30 to 89 mL/min): Start with low dose, titrate slowly with frequent monitoring
Severe renal impairment (CLcr < 30 mL/min): Avoid use of lithium.
Source: package insert for each medications mentioned above.
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Dr. Harvinder Singh, M.D. (Admin)
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