Starting Dose of Depakote DR for Adults
The recommended initial dose of Depakote DR (divalproex sodium) for adults is 125 mg twice daily (250 mg/day total). 1
Dosing Guidelines by Indication
For Mood Stabilization/Antiagitation
- Initial dose: 125 mg twice daily 1
- Titrate to therapeutic blood level (40 to 90 mcg/mL)
- Generally better tolerated than other mood stabilizers
- Monitor liver enzyme levels, platelets, prothrombin time, and partial thromboplastin time as indicated
For Seizure Disorders
According to the FDA label, dosing varies by seizure type 2:
Complex Partial Seizures:
- Initial dose: 10-15 mg/kg/day
- Increase by 5-10 mg/kg/week to achieve optimal response
- Optimal response typically achieved at doses below 60 mg/kg/day
- If total daily dose exceeds 250 mg, give in divided doses
Simple and Complex Absence Seizures:
- Initial dose: 15 mg/kg/day
- Increase at one-week intervals by 5-10 mg/kg/day until seizures controlled
- Maximum recommended dose: 60 mg/kg/day
- If total daily dose exceeds 250 mg, give in divided doses
Dosing Considerations
Weight-Based Dosing
For weight-based initial dosing (15 mg/kg/day) 2:
- 10-24.9 kg: 250 mg daily
- 25-39.9 kg: 500 mg daily
- 40-59.9 kg: 750 mg daily
- 60-74.9 kg: 1,000 mg daily
- 75-89.9 kg: 1,250 mg daily
Special Populations
Elderly Patients:
- Use lower starting doses due to decreased clearance and greater sensitivity to side effects
- Increase dose more slowly with regular monitoring
- Monitor for fluid/nutritional intake, dehydration, and somnolence 2
Monitoring Parameters
- Therapeutic Range: 50-100 μg/mL for seizures 2
- Safety Monitoring:
- Liver function tests at baseline and periodically
- Complete blood count (platelets)
- Prothrombin time and partial thromboplastin time as indicated 1
Important Considerations
- Thrombocytopenia Risk: Increases significantly at trough plasma concentrations above 110 μg/mL in females and 135 μg/mL in males 2
- Divided Dosing: If total daily dose exceeds 250 mg, it should be given in divided doses 2
- GI Irritation: Patients experiencing GI irritation may benefit from taking with food or slowly building up the dose 2
Titration Schedule
- Increase by 5-10 mg/kg/week to achieve optimal clinical response 2
- For mood disorders, titrate to therapeutic blood level (40-90 μg/mL) 1
- For seizure disorders, therapeutic range is 50-100 μg/mL 2
Starting at a low dose of 125 mg twice daily and gradually titrating upward based on clinical response and tolerability provides the best balance of efficacy and safety for most adult patients beginning Depakote DR therapy.