From the Guidelines
The IV substitute for Depakote DR 500 mg po tid is valproate sodium injection (Depacon) 500 mg IV every 8 hours. When converting from oral Depakote to IV valproate, a 1:1 dose conversion is typically used, maintaining the same total daily dose 1. The IV formulation should be administered as a 60-minute infusion at a concentration not exceeding 14 mg/mL and a rate not exceeding 20 mg/minute to minimize infusion site reactions and hemodynamic side effects.
Key Considerations
- Monitor serum valproic acid levels to ensure therapeutic concentrations (50-100 mcg/mL for most indications) 1.
- The IV formulation is particularly useful when patients cannot take oral medications due to NPO status, impaired consciousness, or gastrointestinal issues.
- Once the patient can resume oral intake, they can be converted back to oral Depakote at the same total daily dose, typically divided into the previous schedule.
Administration Details
- The dose of valproate sodium injection (Depacon) can be up to 30 mg/kg at a rate of 40 mg/min, but for substitution of Depakote DR 500 mg po tid, 500 mg IV every 8 hours is recommended 1.
- Adverse effects of valproate include dizziness, thrombocytopenia, liver toxicity, and hyperammonemia, which should be monitored closely 1.
From the Research
IV Substitute for Depakote DR 500 mg po tid
- The studies provided do not directly address the question of an IV substitute for Depakote DR 500 mg po tid 2, 3, 4, 5, 6.
- However, it is known that valproate is available in different dosage forms for parenteral and oral use 2.
- Valproate is available as valproic acid or sodium valproate, and a combination of the two is also used 5.
- Magnesium valproate and sodium valproate have been compared in terms of safety, tolerability, and efficacy in patients with epilepsy 6.
- The choice of IV substitute may depend on various factors, including the patient's medical condition, the severity of the seizure, and the availability of the medication.
Available Forms of Valproate
- Valproic acid
- Sodium valproate
- Magnesium valproate
- Divalproex sodium (a stable combination of sodium valproate and valproic acid in a 1:1 molar ratio) 5
Considerations for IV Substitute
- The IV substitute should have a similar mechanism of action and efficacy to Depakote DR 500 mg po tid 2, 3.
- The IV substitute should be safe and well-tolerated, with a low incidence of adverse events 6.
- The choice of IV substitute may depend on the patient's individual needs and medical condition 2, 3, 4, 5, 6.