Depakote in Children

Objective: To identify factors (i.e., drug preparation or combinations) that may alter doseage requirements during rapid titration of divalproex sodium.

Method: A retrospective chart review revealed that divalproex was initiated in 45 inpatients (mean age 9 yrs.) over a 1 yr. period. Initiation dose approximated 15 mg/kg/day. Trough blood levels were obtained on day 5 following initiation/dose adjustment.

Results: Initial drug levels were 37–121 ug/ml. Dose titration occurred in 20/45 patients. Divalproex was used most frequently with an atypical antipsychotic (29/45 patients, 13 patients also received a stimulant). A smaller number received monotherapy, concurrent stimulant and/or antidepressant. No significant differences in discharge dose or drug level were apparent by age, sex, or drug combination. Patients administered the divalproex sprinkles formulation (n = 6) required significantly higher doses to achieve comparable blood levels.

Conclusions: Therapeutic levels of divalproex sodium can be achieved quickly following an initial 15 mg/kg oral load. Combination drug therapy does not appear to precipitate toxicity at clinically effective doses. Divalproex formulation may alter doseage requirements acutely.

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