Oral Divalproex Sodium Loading for Adolescent Outpatients With Acute Mania/Hypomania: A Report of 2 Cases

Letter to the Editor

Sir: Treatment with divalproex sodium delayed release (DR)of the manic phase of bipolar disorder in adults results in rapidclinical response after a therapeutic serum concentration of 50µg/mL is achieved. When divalproex treatment was initiated at750 mg/day and daily dosage was subsequently titrated on thebasis of serial serum divalproex sodium concentration determinations(i.e., a standard titration approach), therapeutic levelsand corresponding antimanic response were observed in mostpatients after 5 to 10 days. In contrast, an oral loading strategyof divalproex sodium 20 mg/kg/day produces serum valproicacid concentrations of approximately 80 µg/mL after 1 to 2 daysof treatment.