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  • Title: Successful initiation of combined therapy with valproate sodium injection and divalproex sodium extended-release tablets in the epilepsy monitoring unit.
    Author: Boggs JG, Preis K.
    Journal: Epilepsia; 2005 Jun; 46(6):949-51. PubMed ID: 15946337.
    Abstract:
    PURPOSE: Patients in epilepsy monitoring units (EMUs) often require aggressive initiation or reinitiation of therapy before discharge. We developed a simple dosing scheme using valproate sodium injection (VPA-IV) and divalproex sodium extended-release (VPA-ER) tablets to minimize the time required for initiation of therapy, without increasing the likelihood of seizures and adverse effects. METHODS: We identified 42 patients in the EMU, naïve to VPA-IV and VPA-ER, for whom one of the discharge AEDs included divalproex sodium. On the day of discharge, patients were loaded with 20 mg/kg VPA-IV at 6 mg/kg/min, followed by approximately 20 mg/kg VPA-ER within 1 h. The discharge daily dose of VPA-ER was identical to the dose given after the IV load. We assessed tolerability and seizure occurrence during infusion, at 1 h, 4 h, and 1 week after discharge. RESULTS: All patients tolerated the VPA-IV dose followed by VPA-ER. Four patients reported mild nausea, and two patients reported mild dizziness within 4 h. No seizures or significant changes in heart rate or blood pressure occurred within 4 h, and all patients were discharged the same day. All patients denied systemic complaints at 1 week, and five had seizures during the week after discharge. All patients had improved seizure frequencies at the end of the first week. CONCLUSIONS: VPA-IV is well tolerated and convenient for rapid loading in the EMU. When promptly followed by VPA-ER, seizure control remains excellent.
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