Oral Divalproex Sodium Loading for Adolescent Outpatients With Acute Mania/Hypomania: A Report of 2 Cases

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Letter to the Editor

Sir: Treatment with divalproex sodium delayed release (DR) of the manic phase of bipolar disorder in adults results in rapid clinical response after a therapeutic serum concentration of 50 µg/mL is achieved. When divalproex treatment was initiated at 750 mg/day and daily dosage was subsequently titrated on the basis of serial serum divalproex sodium concentration determinations (i.e., a standard titration approach), therapeutic levels and corresponding antimanic response were observed in most patients after 5 to 10 days. In contrast, an oral loading strategy of divalproex sodium 20 mg/kg/day produces serum valproic acid concentrations of approximately 80 µg/mL after 1 to 2 days of treatment.

J Clin Psychiatry 2008;69(6):1016-1018