title: Successful initiation of combined therapy with valproate sodium injection and divalproex sodium extended-release tablets in the epilepsy monitoring unit.
abstract: OBJECTIVE
  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.
authors.affiliation: Orlando Regional Healthcare, Orlando, Florida 32801, USA. jboggs@medscape.com
authors.forename: Jane G
authors.initials: JG
authors.lastname: Boggs
authors.forename: Keith
authors.initials: K
authors.lastname: Preis
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D000927:Anticonvulsants / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003692:Delayed-Action Preparations; D016903:Drug Monitoring / Q000379:methods*; D004359:Drug Therapy, Combination; D004827:Epilepsy / Q000188:drug therapy*; D005260:Female; D005500:Follow-Up Studies; D006757:Hospital Units / Q000458:organization & administration; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D011446:Prospective Studies; D016896:Treatment Outcome; D014635:Valproic Acid / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D000927:Anticonvulsants; D003692:Delayed-Action Preparations; D014635:Valproic Acid