Abstract

Introduction

Materials & Methods

Results

Discussion & Conclusion

References

Discussion
Board

For terminating an epileptic status, valproate i.v. is increasingly used as a second line drug, as sufficient plasma levels are build up quickly, exceeding equivalent dosage oral peak concentrations by 22 %. However, nothing is known yet whether valproate i.v. loading may also be a valuable tool in treating acute mania by building up more quickly peak concentrations with less gastrointestinal side effects compared to oral loading therapy. Methods: Five bipolar I patients, two of them with euphoric mania, three with a mixed manic state (including one patient with ultra rapid cycling and one with very prominent depressed features) received valproate i.v. in an individual titration scheme, usually between 1800- 2400 mg/d. Results: All but one manic patients showed a rapid and favorable response to i.v. valproate loading (dosage between 1200 and 1800 mg/d), building up sufficient blood levels which were maintained on consecutive oral treatment. The most pronounced response, measured as a sharp decline of the BRMAS score, happened already very early on treatment, usually after 24-48 h. Valproate i.v. was tolerated without problems, especially without gastrointestinal problems, otherwise common in oral loading therapy, and also led to a drastic reduction and tempering out of concomitant benzodiazepine treatment in two cases. Valproate peak concentrations, measured 2 h after the i.v. application, were in the range between 95 and 150 g/ml.

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Poster Number PAgrunze0842
Keywords: valproate, bipolar disorder, mania