From the Guidelines
Depakote (divalproex sodium) can be considered for managing agitation in hospice patients, particularly those with dementia or neuropsychiatric symptoms, as an alternative to antipsychotics, with a typical starting dose of 125-250mg twice daily, as suggested by the guidelines for managing Alzheimer's disease 1. When managing agitation in hospice patients, it is essential to prioritize symptom control and comfort. The guidelines suggest that mood-stabilizing drugs like Depakote can be useful alternatives to antipsychotic agents for controlling severe agitated, repetitive, and combative behaviors 1. Some key points to consider when using Depakote in hospice care include:
- Starting with a low dose and titrating as needed to minimize side effects
- Monitoring for sedation, gastrointestinal upset, and potential liver dysfunction, though comprehensive lab monitoring may be minimized in hospice care based on goals of care
- Considering the use of oral solution or sprinkle capsules for easier administration
- Focusing on symptom management and comfort rather than long-term safety concerns It is also important to note that more recent guidelines, such as those from the European Society for Medical Oncology (ESMO) 1, and the National Comprehensive Cancer Network (NCCN) 1, prioritize the use of antipsychotics and benzodiazepines for delirium management, but Depakote may still be considered as an alternative in certain cases. However, the most recent and highest quality study, which is the 2018 ESMO guidelines 1, does not specifically mention Depakote as a first-line treatment for delirium, but rather recommends olanzapine, quetiapine, and aripiprazole as antipsychotic options. Therefore, the use of Depakote in hospice care should be individualized and based on the specific needs and circumstances of each patient, with careful consideration of the potential benefits and risks, and prioritizing quality of life and effective symptom control.
From the Research
Role of Depakote (Valproate) in Managing Agitation
- There is no direct evidence in the provided studies that discusses the role of Depakote (valproate) in managing agitation in hospice patients 2, 3, 4, 5, 6.
- The studies focus on nonpharmacological interventions, typical antipsychotics, benzodiazepines, and atypical antipsychotics as treatment options for agitation in various settings, including hospice care and intensive care units.
- None of the studies mention Depakote (valproate) as a treatment option for agitation in hospice patients, suggesting that it may not be a commonly used or recommended medication for this specific purpose.
Alternative Treatment Options
- Nonpharmacological interventions, such as tailored interventions, have been shown to be effective in mitigating agitation in hospice patients with dementia 2.
- Typical antipsychotics, such as haloperidol, and benzodiazepines, such as lorazepam, are commonly used to treat acute agitation in various settings 3, 5, 6.
- Atypical antipsychotics, such as ziprasidone and olanzapine, have also been shown to be effective in treating acute agitation, with some studies suggesting that they may be better tolerated and have fewer side effects than typical antipsychotics 3, 5, 6.