We are presently assaying Valproate only in patients being treated for
bi-polar depression. There seems to be evidence in certain American papers
that if the serum/plasma concentration of Valproate is >50 mg/L there is
therapeutic benefit. We are currently reviewing this practice, as there
seems little evidence to support routine measurement of Valproate even in
this instance. If the patient receives the manufactures recommended dose
then serum/plasma will be >50mg/L.
Mike Guillain
Clinical Biochemist
Wansbeck General Hospital
Nothumbria Healthcare NHS Trust
Ashington
Northumberland
voice : +44(0)1670529713
fax : +44(0)1670529719
email : [log in to unmask]
----- Original Message -----
From: Sue Walker
To: acb mailgroup
Sent: Thursday, April 06, 2000 2:07 PM
Subject: Valproate and bipolar disorder
We don't offer routine measurement of Valproate in epileptics, though we
do measure it for specific clinical problems. We are now getting a lot of
requests for Valproate levels in patients treated for bipolar disorder but I
am not sure why one should need to measure serum levels any more than in
epilepsy? I realise that Valpraote is excellent for bipolar disorder, that
one wishes to achieve serum levels of above but close to 50 mg/L, and that
"time is of the essence" in achieving rapid response in a severely main
patient etc. Any views, references, reviews on why it is harder to predict
serum concentration from dose than in epilepsy? I am aware of both rapid
oral loading and iv loading before oral maintenance dosing, but these seem
to follow standardised dosing regimens. Please help before our
psychiatrists reach outrage stage!
Sue Walker, Salisbury District Hospital.
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