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Depakote Blood Levels


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#1 felgard

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Posted 02 May 2009 - 09:20 PM

I just started on Depakote ER... 250 for 3 days and this is my first day at 500. I am supposed to go up to 1000 eventually.
My question about the blood levels. Can there be an adequate theraputic response at low blood levels? Like for instance, If I decide that 500mg
is all I need to be stable yet the blood test shows below the theraputic range is that ok? Or is it well documented that mood stabalization ONLY
occurs within the normal theraputic range?

I'm asking this because I think it's already starting to help a great deal. I have reduced my dosage of klonopin by half already :mad:

-Felgard
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#2 Anna

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Posted 03 May 2009 - 11:43 AM

I just started on Depakote ER... 250 for 3 days and this is my first day at 500. I am supposed to go up to 1000 eventually.
My question about the blood levels. Can there be an adequate theraputic response at low blood levels? Like for instance, If I decide that 500mg
is all I need to be stable yet the blood test shows below the theraputic range is that ok? Or is it well documented that mood stabalization ONLY
occurs within the normal theraputic range?

I'm asking this because I think it's already starting to help a great deal. I have reduced my dosage of klonopin by half already :mad:

-Felgard


From the main depakote page:

Depakote's Dosage and How to Take Depakote: Depakote, like lithium, is all about blood levels. It's also about which FDA-approved ailment we're discussing. As always, I'm going to mainly cover the adult dosages, as pediatrics is just way too tricky and outside of our experience.
Bipolar disorder - Abbott recommends starting at 750mg a day divided into two doses. I would think that with a 9 to 16-hour half-life three times a day dosing could be useful, and there is a study to back that up. Abbott is all about ramping the dosage up "as rapidly as possible" until you either get the desired clinical effect or you reach the sweet spot of the blood plasma level - somewhere between 50 and 125. They expect you to do that within 14 days and damn any GI trouble you might be having.

What do they think we are crazy or something?

Then, get this, the maximum recommended dosage is 60mg/kg/day. What does that mean? It means if you weigh 150 pounds your doctor could keep upping your dosage to 4,000mg a day if you're still flipping out! After just two weeks!

That, friends, is crazy.

And we're not the only ones who think so. Once again there's a study that indicates Depakote is at least as effective as lithium and Zyprexa at controlling mania when started at 750mg a day. But it's taken three times a day, the titration is slower, the blood level is between 40 and 150 and the maximum dosage is 750mg plus 20mg/kg/day. Thus the maximum dosage for someone weighing in at 150 pounds would be a much more reasonable 2,000mg a day.

In a big, long study comparing Zyprexa to Depakote, Zyprexa tested somewhat better. But, hey, guess what? That was an Eli Lilly study, so there's no surprise there. But look at the numbers for Depakote. In my readings of the PI sheets of Lilly products and studies done by Lilly researchers I've noticed one thing, they are totally on the ball when it comes to pharmacokinetics and how drugs hit your liver. And here we have people taking 500mg of Depakote and it was effective! They also topped off at a rather sane maximum dosage of 2,500mg a day. Once again my hat is off to the Eli Lilly researchers.


Meaning, yes, you can have effectiveness at lower dosages if you are lucky. The reason for blood tests is that everyone's liver chews through this stuff differently, so blood levels are a more effective GUIDE to docs than dosages. But, that doesn't mean that "subtherapeutic" dosages won't WORK, if you are lucky, for some people they do.

I am on 500 m.g. of Depkote for prophylaxis. Usually, if I find myself heading into the manic direction, THEN I will up it slightly. But, it's mid spring, and this year I am still doing quite fine.

Anna
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Anna

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#3 bittersweet

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Posted 07 May 2009 - 09:28 AM

I'm on combo therapy with depakote (now down to 500 mg) and lithium (450 mg) so both of my levels are probably sub-therapeutic. But there is a big range for therapeutic levels for depakote. I was way too sleepy and had bad tremors on higher doses of depakote so we lowered it since the lithium seemed to be helping me a great deal.

I also have my thyroid monitored pretty regularly.
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Current treatment for the mentally interesting stuff: Fanapt, fluvoxamine (luvox), melatonin, ambien. Currently in maintenance treatment with ECT- partial response. Other meds: nexium, pepcid AC, flonase spray

Meds I have tried: prozac, trazodone, desipramine, nortriptyline, other TCA's, wellbutrin, diazepam, xanax, paxil, zoloft, effexor, lithium, depakote, zyprexa, buspar, neurontin, topomax, lamictal, abilify, trileptal, various sleep meds (ambien, halcion, rozerem, lunesta), cymbalta, pristiq, nuvigil, wellbutrin XL, celexa, geodon, saphris, lexapro, viibryd, and there may be more - yes I have been called treatment-resistant!

#4 In_Remission_scumbellina

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Posted 13 May 2009 - 07:00 AM

Hello Felgard - this is my first post - I also think Depakote is helping me, even at a low dose, and I'm also wondering about the serum levels or whatever-you'd-call-it...
I started taking it nearly 6 weeks ago - due to a combination of things I haven't seen the psych. since then, but hopefully will in a few days. (started 250mg a day for two days, then 250mg twice a day. Still there, for now. Probably will put it up a bit soon.)
I intend to ask him about blood tests - as far as I have heard, in the UK, on the National Health Service as I am, you only get blood tests with Lithium. This hacks me right off, I am pretty militant about 'dammit you should be monitoring me as closely as possible if you're going to expect me to take these toxic chemicals'... although as i said, I think the D. is helping me - my manic energy has gone (so I've got much less energy and enthusiasm than usual- but I don't want to kill people and punch myself in the face) and the depression is calmer and less tempestuous... basically I'm mostly sad, instead of mostly ragingly pissed off. My moods are still changing pretty fast (for example, this morning, woke feeling hellish, cried a lot for 20 minutes, then went to the supermarket, feeling fine, really, just a bit puffy...)
The point is, I don't want the doctor to think I'm saying "this is toxic, check my levels or I won't take it", but I do want to know what the levels are, so that we can get a clue about where the dose should be put up to. I'd happily up the dose a bit, just to see what happens, it's gone pretty well so far. But I want to get the levels done if I'm going to do that. And if the tests are available, I want them done, not dismissed in the name of economy, or whatever...
Sorry, that all seems a bit rambling and pointless now I've typed it. I'm obviously a wee bit hypo, in terms of typing, anyway.
I just want to keep up with how things are going for you with Depakote, what the docs say about blood tests, and so on. Let us know. I'll try to let you guys know what my doc says too.

Scumbellina

#5 In_Remission_lilruby

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Posted 22 May 2009 - 04:28 PM

I have been on Depakote for about 8 weeks now and started at 500 mg per day. This is treating bipolar disorder. My doctor recently instructed me to increase my dosage to 500 mg twice a day. I have noticed a decline in dental health from being on so many psych meds. Is this a common thing? I'd hate for all my teeth to fall out and have to wear dentures at a young age, or at any age at all for that matter.

Anyhoo. About 3 years ago I was admitted to the hospital and they put me on 1500 mg of Depakote ER and my levels became toxic. I began acting crazy, I don't recall any of it. My husband told me that I poured coca cola all over the kitchen and rolled around in it. LOL Some other odd things happened as well. So I'm a bit nervous about this increase in the dosage. I'll have my doctor write an order to have my blood work checked for therapeutic levels.

I have also found that all I want to do is EAT while taking this medication. Anyone else have this problem??????

Angelina

#6 Anna

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Posted 22 May 2009 - 05:00 PM

This thread goes into the effect of meds on teeth. It's not good news. Sorry.

http://www.crazymeds...dental problems

If you became toxic on depakote before, you should have a doc monitoring your blood levels to make sure it doesn't happen again.

Hunger and weight gain are a common side effect of depakote. Depakote ER may reduce this s.e. slightly, some say.

Anna
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Anna

Diagnosed Bipolar Type I, most recently Mixed.

Current Meds: Seroquel, Risperdal, Neurontin, Provigil.

#7 felgard

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Posted 21 June 2009 - 10:30 AM

UPDATE: 500mg depakote is doing very good things for leveling out my moods and decreasing my anxiety, anger and racing thoughts. It has also helping with the anxiety to where I need about 1/3 the amout of klonopin I used to. I must say this is a fine addition to my coctail. I still havent got my valproic acid levels checked yet, but will soon. My pdoc does want a blood level but only when he thinks i'm at the correct dose, so far it seems as if 500mg is doing the trick. I'm a pretty big guy so 500mg is very low for me. No side effects either!

We have also recently added Neurontin to help my anxiety symptoms.

If any of you have questions, I would be more than happy to answer them...

-Felgard
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