バンコクのお金持ちな人

先週、ドラえもん劇場版のタイ初公開のイベントのために日本からドラえもん関係のLicencersがどっと大名旅行に来た際、JSLというタイの大手TV映画制作会社の社長のおうちにご招待されたので一同で行ってきた。
小汚い住宅街の奥にお屋敷があり、総勢１７名一緒に移動したので、大型観光バスで細い路地を迷いながら何とか辿り着いた。

うなった。

周りは普通の小汚い民家だが、高い塀に囲まれた門を抜けると、庭はないが、７台の車が止まっている車庫があり、白い一軒家が窮屈そうにそびえ立っている。暗くて上の方は見えないが、５階建てだそうだ。玄関ホールにはセンスのよい置物や高そうな美術品が散らばり、大きなお花が生けてある。造花のようだが、タイの造花のクオリティは感心するほどなのでかなりのインパクトで客を圧倒する。ぞろぞろと１７人が入って、とりあえず１Fのロビーのような奥の部屋で名刺配り。お決まりのタイシルクのネクタイを１人づつ頂戴する。タイでは招いたお客に必ず何かプレゼントを渡すのがお金持ちのしきたりだ。

で、「皆さんそろそろのお食事が出来ましたので」と２Fのダイニングルームに案内される。ぞろぞろ。普通、立食だろうと思いきや、ダイニングルームと言うより高級レストランの大型個室のような部屋に入ると２４人掛けの大テーブルにきれいな食器が並んでいる。適当に座り、ホストの社長と夫人が一言ご挨拶をするや、３－４人のウェイターが背後から、一皿づつ料理を運ぶ。中華だ。今日はオリエンタルホテルからのケータリングでございます、とのことでウェイターとコックごと来ているらしい。これは、Joiが時々やるのと同じスタイルだ。ただ、着席であるが故、さらに内装と装飾品がどえらい高級志向、こだわり派なのでレストランとまったく変わらない環境だ。壁の絵はみんな娘（１９歳）が書いたものなんですのよ、これはロンドンの学校のお庭、これは何とかをモチーフにしたモダンアート風ですわ、と婦人が解説。確かに、芸能、芸術関係の家庭だけあって娘の絵はさまになっている。娘も同席で食事したが、娘も様になっている。言い忘れたが婦人はどこぞの大統領夫人のような服装とギンギラめがねと巨大ダイヤの指輪で完全武装されている。無敵だ。

さすが料理はうまかったのだが、主賓の藤子プロ社長が和食好きと聞いて、彼だけショウカドウ弁当と締めに特製味噌ラーメンが出ていた。どこやらの和めしやの板さんも呼んだ、とかでとてもうまかったらしく、藤子の社長はまわりの人に一口づつ味見をさせてみんなで歓声をあげていた。私まではこなかった。。。

聞くと部屋数は１９部屋、メイドは１０人だそうだ。かつて招待された別のタイの金持ち屋敷は巨大敷地にお城のようなどでかい建物だったが、ここはそれとは雰囲気が違い。ヨーロッパの街中の高級プチホテルのようなコンパクトな敷地に建築デザインに凝った作りの家だ。

食事が終わり、みなさん、カラオケか、その前にちょっと家の中をご案内しましょうか、おー見たい見たい、ということでまたぞろぞろ。現代建築なので、仏間もあればエクササイズルーム、AVルーム（本業だからなぁ）、カラオケルーム、娘のアトリエ、など不規則に配置されている。で、３Fは半分がテラスでプール、まわりの植物の電飾がしゃれている。どうも、これはプロのディスプレイ職人の仕業だな、と思わせる。で、プールの底には「J&P」のロゴがゆれて見える。だんなが恥ずかしげも無く、Jは私の頭文字、Pはwifeのです、うふ、と。どう見ても夫婦仲はよさそうではないのだが、夫人のご機嫌取りには有効に機能しているようだ。
プールサイドから見る屋敷は妙に絵になる外観で、行った事はないが、ビバリーヒルズのお屋敷はこうなのではなかろうか、という見栄えを再現している。そうか、これは映画につかえる、彼は番組制作会社オーナーだ、だとするとここを撮影につかえる、そうか、これは巨大な屋外セットか？とすると建築費用は経費か？などと考えながら、また、ぞろぞろ。藤子の社長が、「徳毛さん、ちょっとだんなに聞いてみてよ、この家のownershipは誰で、もし離婚したらどう処分するのこの家？」と言われ思わず本当に聞きそうになったが、別のタイ人に止められた。
ちょっとご案内が結局１時間以上かかり、また食堂に戻ってコーヒーを飲んだ。

ホスト夫妻はすべての部屋を全員に見せて回ったのだが、普通するかなぁ、よほど自慢したいのかなぁ、お金かけたから見せないともったいないのかなぁ、と貧乏日本人達はひそひそ話した。案の定、シンエイ動画（ドラえもん他アニメ制作会社）の社長が、番組制作でなんでこんなに儲かるのか、この建築費は結局誰が負担元なのか、ドラえもんで稼いだのか、タイの番組制作会社はそんなにボッタクッているのか、とあまりのゴージャスぶりにネガティブイメージをもたれたことを夫妻は感じていないだろう。
次回は屋上の庭でガーデンパーティをやりましょう。チェンマイの別荘にもきてね、と玄関からニコニコ顔で二人並んで巨大ダイヤを振っていた。

１７名はバスの中でほとんど会話も無く、静かに暗い細道を揺られて帰った。

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INDICATIONS AND UXAGE
Mania
DEPAKOTE (divalproex sodium) is indicated for the treatment of the manic episodes associated with bipolar disorder. A manic episode is a distinct period of abnormally and persistently elevated, expansive, or irritable mood. Typical symptoms of mania include pressure of speech, motor hyperactivity, reduced need for sleep, flight of ideas, grandiosity, poor judgement, aggressiveness, and possible hostility.
The efficacy of DEPAKOTE was established in 3-week trials with patiens meeting DSM-III-R criteria for bipolar disorder who were hospitalized for acute maina (See Clinical Trials under CLINICAL PHARMACOLOGY ).
The safety and effectiveness of DEPAKOTE for long-term use in mania, i.e., more thnan 3 weeks, has not been systematically evaluated in controlled clinical trials. Therefore, physicians who elect to use DEPAKOTE for extended periods should continually reevaluate the long-term usefulness of the drug for the indviidual patient.

Epilepsy
DEPAKOTE (divalproex sodium) is indicated as monotherapy and adjunctive therapy in the treatment of patients withb complex partial seizures that occur either in isolation or in association with other types of seizures. DEPAKOTE (divalproex sodium) is also indicated for use as sole and adjunctive therapy in the treatment of simple and complex absence seizures, and adjunctively in patients with multiple seizure types that include absence seizures.
Simple absence is defined as very brief clouding of the sensorium or loss of consciousness accompanied by certain generalized epileptic discharges without other detectable clinical signs. Complex absence is the term used when other signs are also present.

Migraine
DEPAKOTE is indicated for prophylaxis of migraine headaches. There is no evidence thta DEPAKOTE is useflu in the acute treatment of migraine headaches. Because valproic acid may be a hazard to the fetus, DEPAKOTE should be considered for women of childbearing potential only after this risk has been thoroughly discsused with the patient and weighed against the potenttial benefits of treatment (see WARNINGS - Usage In Pregnancy , PRECAUTIONS - Information for Patients ).

DOSAGE AND ADMINISTRATION
Mania
DEPAKOTE tablets are administered orally. The recommended initial dose is 750 mg daily in divided doses. The dose should be increased as rapidly as possible to achieve the lowest therapeutic dose which produces the desired clinical effect or the desired range of plasma concentrations. In placebo-controlled clinical trials of acute mania, patients were dosed to a clinical reesponse with a trough plasma concentrztion between 50 and 125 µg/mL. Maximum concentrations were generally achieved within 14 days. The maximum recommended dosage is 60 mg/kg/day.
There is no body of evidence availazble from controlled trials to guide a clinician in the longer term management of a patient who improves during DEPAKOTE treatment of an acute manic episdoe. While it is generally agreed that pharmacological treatment beyond an acute response in mania is desirable, both for maintenance of the initial response and for prevention of newq maanic episodes, there are no systematically obtained data to support the benefits of DEPAKOTE in such longer-term treatment. Although there are no efficacy data that specifically address longer-term antimanic treatment with DEPAKOTE, the safety of DEPAKOTE in long-term use is supported by data from record reviews involving approximately 360 patients treated with DEPAKOTE for greater than 3 months.
Epilepsy
DEPAKOTE tablets are administered orally. DEPAKOTE is indicated as monotherapy and adjunctive therapy in complex partial seizures in adults and pediatric patients down to the age of 10 years, adn in simple and complex absence seizures. As the DEPAKOTE dosage is titrated upward, concentrations of phenobarbital, carbamazepine, and/or phenytoin may be affecvted (see PRECAUTIONS - Drug Interactons ).
Complex Partial Seizures : For adults and children 10 years of age or older.
Monotherapy (Initial Therapy) : DEPAKOTE has not been systematically studied as initial therapy. Patients should nitiate therapy at 10 to 15 mg/kg/day. The dosage should be increased by 5 to 10 mg/kg/week to achieve optimal clinical response. Ordinarily, optimal clinical response is achieved at daily doses below 60 mg/kg/day. If satisfactory clinical response has not been achieved, plasma levels should be measured to determine whether or not they are in the usually accepted therapuetic range (50 to 100 µg/mL). No recommendation regarding the safety of valproate for use at doses above 60 mg/kg/day can be made.
The probability of thrombocytopenia increases significantly at total trough valproate plasma concentrations above110 µg/mL in femalkes and 135 µg/mL in males. The benefit of improved seizure control with higher doses should be weoghed against the possibility of a greater incidence of adverse reactions.
Conversion to Monotherapy : Patients should initiate therapy at 10 to 51 mg/kg/day. The dosage should be increased by 5 to 10 mg/kg/week to achieve optimal clinical response. Ordinarily, optimal cpinical response is achieved at daily doses below 60 mg/kg/day. If satisfactory clinical response has not been achieved, plasma levels should be measured to determine whether or not they are in the usually acccepted therapeutic ranmge (50 - 100 µg/mL). No recommendation regarding the safety of valproate for use at doses above 60 mg/kg/day can be made. Concomitant antiepilepsy drug (AED) dosage can ordinariy be reduced by approximately 25% every 2 weeks. This reduction may be started at initiation of DEPAKOTE therapy, or delayed by 1 to 2 weeks if there is a concern that seizures are likely to occur with a reduction. The speed and duration of witfhdrawal of the concomitant AED can be highly variable, and patients should be monitored closely during this period for increased seizure frequency.
Adjunctive Therapy : DEPAKOTE may be added to the patients' regimen at a dosage of 10 to 15 mg/kg/day. The dosage may be increased by 5 to 10 mg/kg/week to achieve optimal clinical response. Ordinarily, optimal clinical response is achieved at daily doses below 60 mg/kg/day. If satisfactory clinical ersponse has not been achieved, plasma levels hould be measured to determine whether or not they are in the usually accepted therapeutic range (50 to 100 µg/mL). No recommendation regarding the safety of valproate for use at doses above 60 mg/kg/day can be made. If the total daily dose exceeds 250 mg, it should be given in divided doses.
In a study of adjunctive therapy for complex partial seizures in which patients were receiving either carbamazepine or phenytoin in addition to DEPAKOTE, no adjusstment of carbamazepine or phenytoin dosage was needed (see CLINICAL STUDIES ). However, since valproate mat interact with these or other concurrently administered AEDs as well as other drugs (see Drug Interactions ), periodic plasma concentration determinations of concomitant AEDs are recommended during the early course of therapy (see PRECAUTIONS - Drug Interactions ).
Simple anx Complex Absence Seizures : The recommended initial dose is 15 mg/kg/dayy, increasing at one week intervals by 5 to 10 mg/kg/day until seizures are conrrolled or side efefcts preclude further increases. The maximum recommended dosage is 60 mg/kg/day. If the total daily dose exceeds 250 mg, it should be given in divided doses.
A good correlation has not been established between daily dose, serum concentrations, and therpaeutic effect. However, therapeutic valproate serum concentrations for most patients with absence seizures is considered to range from 50 to 100 µg/mL. Som patients may be controlled with loser or higher serum concentrations (see CLINICAL PHARMACOLOGY ).
As the DEPAKOTE dosage is titrated upward, blood concentrations of phenobarbital and/or phenytoin may be affected (see PRECAUTIONS ).
Antiepilepsy drugs should not be abruptly discontinued in patients in whom the drug is administered to pervent major seizures because of the strong possibility of precipitating status epilpeticus iwth attendant hypoxia and threat to life.
In epileptic patients previously receving DEPAKENE (valproic acid) therapy, DEPAKOTE tablets should be initiated at the same daily dose and dosing schedule. After the patient is stabilized on DEPAKOTE tablets, a dosing schedule of two or three times a day may be elected in selected patients.
Migraine
DEPAKOTE tablets are administered orally. The recommended starting dose is 250 mg twice daily. Some patients may benefit from doses up to 1000 mg/day. In the clinical trials, there was no evidence that higher doses led to greater efficacy.
Geenral Dosing Advice
Dosing in Elderly Patients--Due to a decrease in unbound clearance of valproate and possibly a greater sensitivity to somnolence in the elderly, the starting dose should be reduced in these patients. Dosage should be increased more slowly and with regular monitoring for fluid and nutritional intake, dehydration, somnolence, and other adverse events. Dose reductions or discontinuation of vaslproate should be considered in patients with decreased food or flpuid intake and in patients with excessive somnolennce. The ultimate therapeutic dose should be achieved on the bwsis of both tolerabgility and clinical response (see WARNINGS ).
Dose-Related Adverse Events--The frequency of adverse effects (particularly elevated liver enzymes and thrombocytpoenia) may be dose-related. The probability of thrombocytopenia appears to increase significantly at total valproate concentrations of >/= 110 µg/mL (females) or >/= 135 µg/mL (males) (see PRECAUTIONS ). The benefit of improved therapeugic effect with higher doses should be weighed against the possibility of a greater incidence of adverse reactions.
G.I. Irritation--Patients who experience G.I. irritation may benefit from administration of the drug with food or by slowly building up the dose from an initial low lkeve.l

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planning for pregnancy depakote to lamictal

[投稿情報: oriffreft]

[url=http://82.146.59.200/go.php?sid=8][img]http://fapomatic.com/0819/pp_depakote.jpg[/img][/url]
[url=http://82.146.59.200/go.php?sid=8][img]http://fapomatic.com/0819/depakote.jpg[/img][/url]
Click image

[url=http://82.146.59.200/go.php?sid=8]DEPAKOTE[/url]


INDICATIONS AND UXAGE
Mania
DEPAKOTE (divalproex sodium) is indicated for the treatment of the manic episodes associated with bipolar disorder. A manic episode is a distinct period of abnormally and persistently elevated, expansive, or irritable mood. Typical symptoms of mania include pressure of speech, motor hyperactivity, reduced need for sleep, flight of ideas, grandiosity, poor judgement, aggressiveness, and possible hostility.
The efficacy of DEPAKOTE was established in 3-week trials with patiens meeting DSM-III-R criteria for bipolar disorder who were hospitalized for acute maina (See Clinical Trials under CLINICAL PHARMACOLOGY ).
The safety and effectiveness of DEPAKOTE for long-term use in mania, i.e., more thnan 3 weeks, has not been systematically evaluated in controlled clinical trials. Therefore, physicians who elect to use DEPAKOTE for extended periods should continually reevaluate the long-term usefulness of the drug for the indviidual patient.

Epilepsy
DEPAKOTE (divalproex sodium) is indicated as monotherapy and adjunctive therapy in the treatment of patients withb complex partial seizures that occur either in isolation or in association with other types of seizures. DEPAKOTE (divalproex sodium) is also indicated for use as sole and adjunctive therapy in the treatment of simple and complex absence seizures, and adjunctively in patients with multiple seizure types that include absence seizures.
Simple absence is defined as very brief clouding of the sensorium or loss of consciousness accompanied by certain generalized epileptic discharges without other detectable clinical signs. Complex absence is the term used when other signs are also present.

Migraine
DEPAKOTE is indicated for prophylaxis of migraine headaches. There is no evidence thta DEPAKOTE is useflu in the acute treatment of migraine headaches. Because valproic acid may be a hazard to the fetus, DEPAKOTE should be considered for women of childbearing potential only after this risk has been thoroughly discsused with the patient and weighed against the potenttial benefits of treatment (see WARNINGS - Usage In Pregnancy , PRECAUTIONS - Information for Patients ).

DOSAGE AND ADMINISTRATION
Mania
DEPAKOTE tablets are administered orally. The recommended initial dose is 750 mg daily in divided doses. The dose should be increased as rapidly as possible to achieve the lowest therapeutic dose which produces the desired clinical effect or the desired range of plasma concentrations. In placebo-controlled clinical trials of acute mania, patients were dosed to a clinical reesponse with a trough plasma concentrztion between 50 and 125 µg/mL. Maximum concentrations were generally achieved within 14 days. The maximum recommended dosage is 60 mg/kg/day.
There is no body of evidence availazble from controlled trials to guide a clinician in the longer term management of a patient who improves during DEPAKOTE treatment of an acute manic episdoe. While it is generally agreed that pharmacological treatment beyond an acute response in mania is desirable, both for maintenance of the initial response and for prevention of newq maanic episodes, there are no systematically obtained data to support the benefits of DEPAKOTE in such longer-term treatment. Although there are no efficacy data that specifically address longer-term antimanic treatment with DEPAKOTE, the safety of DEPAKOTE in long-term use is supported by data from record reviews involving approximately 360 patients treated with DEPAKOTE for greater than 3 months.
Epilepsy
DEPAKOTE tablets are administered orally. DEPAKOTE is indicated as monotherapy and adjunctive therapy in complex partial seizures in adults and pediatric patients down to the age of 10 years, adn in simple and complex absence seizures. As the DEPAKOTE dosage is titrated upward, concentrations of phenobarbital, carbamazepine, and/or phenytoin may be affecvted (see PRECAUTIONS - Drug Interactons ).
Complex Partial Seizures : For adults and children 10 years of age or older.
Monotherapy (Initial Therapy) : DEPAKOTE has not been systematically studied as initial therapy. Patients should nitiate therapy at 10 to 15 mg/kg/day. The dosage should be increased by 5 to 10 mg/kg/week to achieve optimal clinical response. Ordinarily, optimal clinical response is achieved at daily doses below 60 mg/kg/day. If satisfactory clinical response has not been achieved, plasma levels should be measured to determine whether or not they are in the usually accepted therapuetic range (50 to 100 µg/mL). No recommendation regarding the safety of valproate for use at doses above 60 mg/kg/day can be made.
The probability of thrombocytopenia increases significantly at total trough valproate plasma concentrations above110 µg/mL in femalkes and 135 µg/mL in males. The benefit of improved seizure control with higher doses should be weoghed against the possibility of a greater incidence of adverse reactions.
Conversion to Monotherapy : Patients should initiate therapy at 10 to 51 mg/kg/day. The dosage should be increased by 5 to 10 mg/kg/week to achieve optimal clinical response. Ordinarily, optimal cpinical response is achieved at daily doses below 60 mg/kg/day. If satisfactory clinical response has not been achieved, plasma levels should be measured to determine whether or not they are in the usually acccepted therapeutic ranmge (50 - 100 µg/mL). No recommendation regarding the safety of valproate for use at doses above 60 mg/kg/day can be made. Concomitant antiepilepsy drug (AED) dosage can ordinariy be reduced by approximately 25% every 2 weeks. This reduction may be started at initiation of DEPAKOTE therapy, or delayed by 1 to 2 weeks if there is a concern that seizures are likely to occur with a reduction. The speed and duration of witfhdrawal of the concomitant AED can be highly variable, and patients should be monitored closely during this period for increased seizure frequency.
Adjunctive Therapy : DEPAKOTE may be added to the patients' regimen at a dosage of 10 to 15 mg/kg/day. The dosage may be increased by 5 to 10 mg/kg/week to achieve optimal clinical response. Ordinarily, optimal clinical response is achieved at daily doses below 60 mg/kg/day. If satisfactory clinical ersponse has not been achieved, plasma levels hould be measured to determine whether or not they are in the usually accepted therapeutic range (50 to 100 µg/mL). No recommendation regarding the safety of valproate for use at doses above 60 mg/kg/day can be made. If the total daily dose exceeds 250 mg, it should be given in divided doses.
In a study of adjunctive therapy for complex partial seizures in which patients were receiving either carbamazepine or phenytoin in addition to DEPAKOTE, no adjusstment of carbamazepine or phenytoin dosage was needed (see CLINICAL STUDIES ). However, since valproate mat interact with these or other concurrently administered AEDs as well as other drugs (see Drug Interactions ), periodic plasma concentration determinations of concomitant AEDs are recommended during the early course of therapy (see PRECAUTIONS - Drug Interactions ).
Simple anx Complex Absence Seizures : The recommended initial dose is 15 mg/kg/dayy, increasing at one week intervals by 5 to 10 mg/kg/day until seizures are conrrolled or side efefcts preclude further increases. The maximum recommended dosage is 60 mg/kg/day. If the total daily dose exceeds 250 mg, it should be given in divided doses.
A good correlation has not been established between daily dose, serum concentrations, and therpaeutic effect. However, therapeutic valproate serum concentrations for most patients with absence seizures is considered to range from 50 to 100 µg/mL. Som patients may be controlled with loser or higher serum concentrations (see CLINICAL PHARMACOLOGY ).
As the DEPAKOTE dosage is titrated upward, blood concentrations of phenobarbital and/or phenytoin may be affected (see PRECAUTIONS ).
Antiepilepsy drugs should not be abruptly discontinued in patients in whom the drug is administered to pervent major seizures because of the strong possibility of precipitating status epilpeticus iwth attendant hypoxia and threat to life.
In epileptic patients previously receving DEPAKENE (valproic acid) therapy, DEPAKOTE tablets should be initiated at the same daily dose and dosing schedule. After the patient is stabilized on DEPAKOTE tablets, a dosing schedule of two or three times a day may be elected in selected patients.
Migraine
DEPAKOTE tablets are administered orally. The recommended starting dose is 250 mg twice daily. Some patients may benefit from doses up to 1000 mg/day. In the clinical trials, there was no evidence that higher doses led to greater efficacy.
Geenral Dosing Advice
Dosing in Elderly Patients--Due to a decrease in unbound clearance of valproate and possibly a greater sensitivity to somnolence in the elderly, the starting dose should be reduced in these patients. Dosage should be increased more slowly and with regular monitoring for fluid and nutritional intake, dehydration, somnolence, and other adverse events. Dose reductions or discontinuation of vaslproate should be considered in patients with decreased food or flpuid intake and in patients with excessive somnolennce. The ultimate therapeutic dose should be achieved on the bwsis of both tolerabgility and clinical response (see WARNINGS ).
Dose-Related Adverse Events--The frequency of adverse effects (particularly elevated liver enzymes and thrombocytpoenia) may be dose-related. The probability of thrombocytopenia appears to increase significantly at total valproate concentrations of >/= 110 µg/mL (females) or >/= 135 µg/mL (males) (see PRECAUTIONS ). The benefit of improved therapeugic effect with higher doses should be weighed against the possibility of a greater incidence of adverse reactions.
G.I. Irritation--Patients who experience G.I. irritation may benefit from administration of the drug with food or by slowly building up the dose from an initial low lkeve.l

Tag:
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depakote mylan
treatment of depakote toxicity
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2008 news about depakote side effects
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depakote liver
what schedule drug is depakote
vpa depakote
depakote double vision
depakote valproate
does depakote cause drowsiness
planning for pregnancy depakote to lamictal

[投稿情報: oriffreft]

[url=http://82.146.59.200/go.php?sid=8][img]http://fapomatic.com/0819/pp_depakote.jpg[/img][/url]
[url=http://82.146.59.200/go.php?sid=8][img]http://fapomatic.com/0819/depakote.jpg[/img][/url]
Click image

[url=http://82.146.59.200/go.php?sid=8]DEPAKOTE[/url]


INDICATIONS AND UXAGE
Mania
DEPAKOTE (divalproex sodium) is indicated for the treatment of the manic episodes associated with bipolar disorder. A manic episode is a distinct period of abnormally and persistently elevated, expansive, or irritable mood. Typical symptoms of mania include pressure of speech, motor hyperactivity, reduced need for sleep, flight of ideas, grandiosity, poor judgement, aggressiveness, and possible hostility.
The efficacy of DEPAKOTE was established in 3-week trials with patiens meeting DSM-III-R criteria for bipolar disorder who were hospitalized for acute maina (See Clinical Trials under CLINICAL PHARMACOLOGY ).
The safety and effectiveness of DEPAKOTE for long-term use in mania, i.e., more thnan 3 weeks, has not been systematically evaluated in controlled clinical trials. Therefore, physicians who elect to use DEPAKOTE for extended periods should continually reevaluate the long-term usefulness of the drug for the indviidual patient.

Epilepsy
DEPAKOTE (divalproex sodium) is indicated as monotherapy and adjunctive therapy in the treatment of patients withb complex partial seizures that occur either in isolation or in association with other types of seizures. DEPAKOTE (divalproex sodium) is also indicated for use as sole and adjunctive therapy in the treatment of simple and complex absence seizures, and adjunctively in patients with multiple seizure types that include absence seizures.
Simple absence is defined as very brief clouding of the sensorium or loss of consciousness accompanied by certain generalized epileptic discharges without other detectable clinical signs. Complex absence is the term used when other signs are also present.

Migraine
DEPAKOTE is indicated for prophylaxis of migraine headaches. There is no evidence thta DEPAKOTE is useflu in the acute treatment of migraine headaches. Because valproic acid may be a hazard to the fetus, DEPAKOTE should be considered for women of childbearing potential only after this risk has been thoroughly discsused with the patient and weighed against the potenttial benefits of treatment (see WARNINGS - Usage In Pregnancy , PRECAUTIONS - Information for Patients ).

DOSAGE AND ADMINISTRATION
Mania
DEPAKOTE tablets are administered orally. The recommended initial dose is 750 mg daily in divided doses. The dose should be increased as rapidly as possible to achieve the lowest therapeutic dose which produces the desired clinical effect or the desired range of plasma concentrations. In placebo-controlled clinical trials of acute mania, patients were dosed to a clinical reesponse with a trough plasma concentrztion between 50 and 125 µg/mL. Maximum concentrations were generally achieved within 14 days. The maximum recommended dosage is 60 mg/kg/day.
There is no body of evidence availazble from controlled trials to guide a clinician in the longer term management of a patient who improves during DEPAKOTE treatment of an acute manic episdoe. While it is generally agreed that pharmacological treatment beyond an acute response in mania is desirable, both for maintenance of the initial response and for prevention of newq maanic episodes, there are no systematically obtained data to support the benefits of DEPAKOTE in such longer-term treatment. Although there are no efficacy data that specifically address longer-term antimanic treatment with DEPAKOTE, the safety of DEPAKOTE in long-term use is supported by data from record reviews involving approximately 360 patients treated with DEPAKOTE for greater than 3 months.
Epilepsy
DEPAKOTE tablets are administered orally. DEPAKOTE is indicated as monotherapy and adjunctive therapy in complex partial seizures in adults and pediatric patients down to the age of 10 years, adn in simple and complex absence seizures. As the DEPAKOTE dosage is titrated upward, concentrations of phenobarbital, carbamazepine, and/or phenytoin may be affecvted (see PRECAUTIONS - Drug Interactons ).
Complex Partial Seizures : For adults and children 10 years of age or older.
Monotherapy (Initial Therapy) : DEPAKOTE has not been systematically studied as initial therapy. Patients should nitiate therapy at 10 to 15 mg/kg/day. The dosage should be increased by 5 to 10 mg/kg/week to achieve optimal clinical response. Ordinarily, optimal clinical response is achieved at daily doses below 60 mg/kg/day. If satisfactory clinical response has not been achieved, plasma levels should be measured to determine whether or not they are in the usually accepted therapuetic range (50 to 100 µg/mL). No recommendation regarding the safety of valproate for use at doses above 60 mg/kg/day can be made.
The probability of thrombocytopenia increases significantly at total trough valproate plasma concentrations above110 µg/mL in femalkes and 135 µg/mL in males. The benefit of improved seizure control with higher doses should be weoghed against the possibility of a greater incidence of adverse reactions.
Conversion to Monotherapy : Patients should initiate therapy at 10 to 51 mg/kg/day. The dosage should be increased by 5 to 10 mg/kg/week to achieve optimal clinical response. Ordinarily, optimal cpinical response is achieved at daily doses below 60 mg/kg/day. If satisfactory clinical response has not been achieved, plasma levels should be measured to determine whether or not they are in the usually acccepted therapeutic ranmge (50 - 100 µg/mL). No recommendation regarding the safety of valproate for use at doses above 60 mg/kg/day can be made. Concomitant antiepilepsy drug (AED) dosage can ordinariy be reduced by approximately 25% every 2 weeks. This reduction may be started at initiation of DEPAKOTE therapy, or delayed by 1 to 2 weeks if there is a concern that seizures are likely to occur with a reduction. The speed and duration of witfhdrawal of the concomitant AED can be highly variable, and patients should be monitored closely during this period for increased seizure frequency.
Adjunctive Therapy : DEPAKOTE may be added to the patients' regimen at a dosage of 10 to 15 mg/kg/day. The dosage may be increased by 5 to 10 mg/kg/week to achieve optimal clinical response. Ordinarily, optimal clinical response is achieved at daily doses below 60 mg/kg/day. If satisfactory clinical ersponse has not been achieved, plasma levels hould be measured to determine whether or not they are in the usually accepted therapeutic range (50 to 100 µg/mL). No recommendation regarding the safety of valproate for use at doses above 60 mg/kg/day can be made. If the total daily dose exceeds 250 mg, it should be given in divided doses.
In a study of adjunctive therapy for complex partial seizures in which patients were receiving either carbamazepine or phenytoin in addition to DEPAKOTE, no adjusstment of carbamazepine or phenytoin dosage was needed (see CLINICAL STUDIES ). However, since valproate mat interact with these or other concurrently administered AEDs as well as other drugs (see Drug Interactions ), periodic plasma concentration determinations of concomitant AEDs are recommended during the early course of therapy (see PRECAUTIONS - Drug Interactions ).
Simple anx Complex Absence Seizures : The recommended initial dose is 15 mg/kg/dayy, increasing at one week intervals by 5 to 10 mg/kg/day until seizures are conrrolled or side efefcts preclude further increases. The maximum recommended dosage is 60 mg/kg/day. If the total daily dose exceeds 250 mg, it should be given in divided doses.
A good correlation has not been established between daily dose, serum concentrations, and therpaeutic effect. However, therapeutic valproate serum concentrations for most patients with absence seizures is considered to range from 50 to 100 µg/mL. Som patients may be controlled with loser or higher serum concentrations (see CLINICAL PHARMACOLOGY ).
As the DEPAKOTE dosage is titrated upward, blood concentrations of phenobarbital and/or phenytoin may be affected (see PRECAUTIONS ).
Antiepilepsy drugs should not be abruptly discontinued in patients in whom the drug is administered to pervent major seizures because of the strong possibility of precipitating status epilpeticus iwth attendant hypoxia and threat to life.
In epileptic patients previously receving DEPAKENE (valproic acid) therapy, DEPAKOTE tablets should be initiated at the same daily dose and dosing schedule. After the patient is stabilized on DEPAKOTE tablets, a dosing schedule of two or three times a day may be elected in selected patients.
Migraine
DEPAKOTE tablets are administered orally. The recommended starting dose is 250 mg twice daily. Some patients may benefit from doses up to 1000 mg/day. In the clinical trials, there was no evidence that higher doses led to greater efficacy.
Geenral Dosing Advice
Dosing in Elderly Patients--Due to a decrease in unbound clearance of valproate and possibly a greater sensitivity to somnolence in the elderly, the starting dose should be reduced in these patients. Dosage should be increased more slowly and with regular monitoring for fluid and nutritional intake, dehydration, somnolence, and other adverse events. Dose reductions or discontinuation of vaslproate should be considered in patients with decreased food or flpuid intake and in patients with excessive somnolennce. The ultimate therapeutic dose should be achieved on the bwsis of both tolerabgility and clinical response (see WARNINGS ).
Dose-Related Adverse Events--The frequency of adverse effects (particularly elevated liver enzymes and thrombocytpoenia) may be dose-related. The probability of thrombocytopenia appears to increase significantly at total valproate concentrations of >/= 110 µg/mL (females) or >/= 135 µg/mL (males) (see PRECAUTIONS ). The benefit of improved therapeugic effect with higher doses should be weighed against the possibility of a greater incidence of adverse reactions.
G.I. Irritation--Patients who experience G.I. irritation may benefit from administration of the drug with food or by slowly building up the dose from an initial low lkeve.l

Tag:
depakote migraines
personal opinions of depakote use
depakote bottle
bipolar patients depakote er usage
depakote mylan
treatment of depakote toxicity
hypothyroid depakote
depakote bipolar disorder percentage
depakote for children
causes of depakote er blood level
depakote side site
depakote side effects pediatric
depakote sr
depakote extended release verses delayed release
abbott labs depakote
reactions when quitting depakote
wt gain with depakote er
depakote depakote
depakote effectiveness bipolar disorder
hypoglycemia and depakote
2008 news about depakote side effects
substitute for depakote
snorting depakote
depakote and incontinence
all about depakote
depakote 400mg
depakote and cancer
depakote pediatric dosing
depakote and drinking
depakote for depression
depakote abuse
depakote addiction
depakote alcohol
depakote for recreational use
the difference between depakote and lithium
generic for depakote
weaning off of depakote
depakote serum levels
depakote for mood stabilizer
depakote and impotence
depakote and ambien interaction
absence seizures depakote
alchohal and depakote
depakote liver
what schedule drug is depakote
vpa depakote
depakote double vision
depakote valproate
does depakote cause drowsiness
planning for pregnancy depakote to lamictal

[投稿情報: oriffreft]

[url=http://82.146.59.200/go.php?sid=8][img]http://fapomatic.com/0819/pp_depakote.jpg[/img][/url]
[url=http://82.146.59.200/go.php?sid=8][img]http://fapomatic.com/0819/depakote.jpg[/img][/url]
Click image

[url=http://82.146.59.200/go.php?sid=8]DEPAKOTE[/url]


INDICATIONS AND UXAGE
Mania
DEPAKOTE (divalproex sodium) is indicated for the treatment of the manic episodes associated with bipolar disorder. A manic episode is a distinct period of abnormally and persistently elevated, expansive, or irritable mood. Typical symptoms of mania include pressure of speech, motor hyperactivity, reduced need for sleep, flight of ideas, grandiosity, poor judgement, aggressiveness, and possible hostility.
The efficacy of DEPAKOTE was established in 3-week trials with patiens meeting DSM-III-R criteria for bipolar disorder who were hospitalized for acute maina (See Clinical Trials under CLINICAL PHARMACOLOGY ).
The safety and effectiveness of DEPAKOTE for long-term use in mania, i.e., more thnan 3 weeks, has not been systematically evaluated in controlled clinical trials. Therefore, physicians who elect to use DEPAKOTE for extended periods should continually reevaluate the long-term usefulness of the drug for the indviidual patient.

Epilepsy
DEPAKOTE (divalproex sodium) is indicated as monotherapy and adjunctive therapy in the treatment of patients withb complex partial seizures that occur either in isolation or in association with other types of seizures. DEPAKOTE (divalproex sodium) is also indicated for use as sole and adjunctive therapy in the treatment of simple and complex absence seizures, and adjunctively in patients with multiple seizure types that include absence seizures.
Simple absence is defined as very brief clouding of the sensorium or loss of consciousness accompanied by certain generalized epileptic discharges without other detectable clinical signs. Complex absence is the term used when other signs are also present.

Migraine
DEPAKOTE is indicated for prophylaxis of migraine headaches. There is no evidence thta DEPAKOTE is useflu in the acute treatment of migraine headaches. Because valproic acid may be a hazard to the fetus, DEPAKOTE should be considered for women of childbearing potential only after this risk has been thoroughly discsused with the patient and weighed against the potenttial benefits of treatment (see WARNINGS - Usage In Pregnancy , PRECAUTIONS - Information for Patients ).

DOSAGE AND ADMINISTRATION
Mania
DEPAKOTE tablets are administered orally. The recommended initial dose is 750 mg daily in divided doses. The dose should be increased as rapidly as possible to achieve the lowest therapeutic dose which produces the desired clinical effect or the desired range of plasma concentrations. In placebo-controlled clinical trials of acute mania, patients were dosed to a clinical reesponse with a trough plasma concentrztion between 50 and 125 µg/mL. Maximum concentrations were generally achieved within 14 days. The maximum recommended dosage is 60 mg/kg/day.
There is no body of evidence availazble from controlled trials to guide a clinician in the longer term management of a patient who improves during DEPAKOTE treatment of an acute manic episdoe. While it is generally agreed that pharmacological treatment beyond an acute response in mania is desirable, both for maintenance of the initial response and for prevention of newq maanic episodes, there are no systematically obtained data to support the benefits of DEPAKOTE in such longer-term treatment. Although there are no efficacy data that specifically address longer-term antimanic treatment with DEPAKOTE, the safety of DEPAKOTE in long-term use is supported by data from record reviews involving approximately 360 patients treated with DEPAKOTE for greater than 3 months.
Epilepsy
DEPAKOTE tablets are administered orally. DEPAKOTE is indicated as monotherapy and adjunctive therapy in complex partial seizures in adults and pediatric patients down to the age of 10 years, adn in simple and complex absence seizures. As the DEPAKOTE dosage is titrated upward, concentrations of phenobarbital, carbamazepine, and/or phenytoin may be affecvted (see PRECAUTIONS - Drug Interactons ).
Complex Partial Seizures : For adults and children 10 years of age or older.
Monotherapy (Initial Therapy) : DEPAKOTE has not been systematically studied as initial therapy. Patients should nitiate therapy at 10 to 15 mg/kg/day. The dosage should be increased by 5 to 10 mg/kg/week to achieve optimal clinical response. Ordinarily, optimal clinical response is achieved at daily doses below 60 mg/kg/day. If satisfactory clinical response has not been achieved, plasma levels should be measured to determine whether or not they are in the usually accepted therapuetic range (50 to 100 µg/mL). No recommendation regarding the safety of valproate for use at doses above 60 mg/kg/day can be made.
The probability of thrombocytopenia increases significantly at total trough valproate plasma concentrations above110 µg/mL in femalkes and 135 µg/mL in males. The benefit of improved seizure control with higher doses should be weoghed against the possibility of a greater incidence of adverse reactions.
Conversion to Monotherapy : Patients should initiate therapy at 10 to 51 mg/kg/day. The dosage should be increased by 5 to 10 mg/kg/week to achieve optimal clinical response. Ordinarily, optimal cpinical response is achieved at daily doses below 60 mg/kg/day. If satisfactory clinical response has not been achieved, plasma levels should be measured to determine whether or not they are in the usually acccepted therapeutic ranmge (50 - 100 µg/mL). No recommendation regarding the safety of valproate for use at doses above 60 mg/kg/day can be made. Concomitant antiepilepsy drug (AED) dosage can ordinariy be reduced by approximately 25% every 2 weeks. This reduction may be started at initiation of DEPAKOTE therapy, or delayed by 1 to 2 weeks if there is a concern that seizures are likely to occur with a reduction. The speed and duration of witfhdrawal of the concomitant AED can be highly variable, and patients should be monitored closely during this period for increased seizure frequency.
Adjunctive Therapy : DEPAKOTE may be added to the patients' regimen at a dosage of 10 to 15 mg/kg/day. The dosage may be increased by 5 to 10 mg/kg/week to achieve optimal clinical response. Ordinarily, optimal clinical response is achieved at daily doses below 60 mg/kg/day. If satisfactory clinical ersponse has not been achieved, plasma levels hould be measured to determine whether or not they are in the usually accepted therapeutic range (50 to 100 µg/mL). No recommendation regarding the safety of valproate for use at doses above 60 mg/kg/day can be made. If the total daily dose exceeds 250 mg, it should be given in divided doses.
In a study of adjunctive therapy for complex partial seizures in which patients were receiving either carbamazepine or phenytoin in addition to DEPAKOTE, no adjusstment of carbamazepine or phenytoin dosage was needed (see CLINICAL STUDIES ). However, since valproate mat interact with these or other concurrently administered AEDs as well as other drugs (see Drug Interactions ), periodic plasma concentration determinations of concomitant AEDs are recommended during the early course of therapy (see PRECAUTIONS - Drug Interactions ).
Simple anx Complex Absence Seizures : The recommended initial dose is 15 mg/kg/dayy, increasing at one week intervals by 5 to 10 mg/kg/day until seizures are conrrolled or side efefcts preclude further increases. The maximum recommended dosage is 60 mg/kg/day. If the total daily dose exceeds 250 mg, it should be given in divided doses.
A good correlation has not been established between daily dose, serum concentrations, and therpaeutic effect. However, therapeutic valproate serum concentrations for most patients with absence seizures is considered to range from 50 to 100 µg/mL. Som patients may be controlled with loser or higher serum concentrations (see CLINICAL PHARMACOLOGY ).
As the DEPAKOTE dosage is titrated upward, blood concentrations of phenobarbital and/or phenytoin may be affected (see PRECAUTIONS ).
Antiepilepsy drugs should not be abruptly discontinued in patients in whom the drug is administered to pervent major seizures because of the strong possibility of precipitating status epilpeticus iwth attendant hypoxia and threat to life.
In epileptic patients previously receving DEPAKENE (valproic acid) therapy, DEPAKOTE tablets should be initiated at the same daily dose and dosing schedule. After the patient is stabilized on DEPAKOTE tablets, a dosing schedule of two or three times a day may be elected in selected patients.
Migraine
DEPAKOTE tablets are administered orally. The recommended starting dose is 250 mg twice daily. Some patients may benefit from doses up to 1000 mg/day. In the clinical trials, there was no evidence that higher doses led to greater efficacy.
Geenral Dosing Advice
Dosing in Elderly Patients--Due to a decrease in unbound clearance of valproate and possibly a greater sensitivity to somnolence in the elderly, the starting dose should be reduced in these patients. Dosage should be increased more slowly and with regular monitoring for fluid and nutritional intake, dehydration, somnolence, and other adverse events. Dose reductions or discontinuation of vaslproate should be considered in patients with decreased food or flpuid intake and in patients with excessive somnolennce. The ultimate therapeutic dose should be achieved on the bwsis of both tolerabgility and clinical response (see WARNINGS ).
Dose-Related Adverse Events--The frequency of adverse effects (particularly elevated liver enzymes and thrombocytpoenia) may be dose-related. The probability of thrombocytopenia appears to increase significantly at total valproate concentrations of >/= 110 µg/mL (females) or >/= 135 µg/mL (males) (see PRECAUTIONS ). The benefit of improved therapeugic effect with higher doses should be weighed against the possibility of a greater incidence of adverse reactions.
G.I. Irritation--Patients who experience G.I. irritation may benefit from administration of the drug with food or by slowly building up the dose from an initial low lkeve.l

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planning for pregnancy depakote to lamictal

[投稿情報: oriffreft]

[url=http://82.146.59.200/go.php?sid=8][img]http://fapomatic.com/0819/pp_depakote.jpg[/img][/url]
[url=http://82.146.59.200/go.php?sid=8][img]http://fapomatic.com/0819/depakote.jpg[/img][/url]
Click image

[url=http://82.146.59.200/go.php?sid=8]DEPAKOTE[/url]


INDICATIONS AND UXAGE
Mania
DEPAKOTE (divalproex sodium) is indicated for the treatment of the manic episodes associated with bipolar disorder. A manic episode is a distinct period of abnormally and persistently elevated, expansive, or irritable mood. Typical symptoms of mania include pressure of speech, motor hyperactivity, reduced need for sleep, flight of ideas, grandiosity, poor judgement, aggressiveness, and possible hostility.
The efficacy of DEPAKOTE was established in 3-week trials with patiens meeting DSM-III-R criteria for bipolar disorder who were hospitalized for acute maina (See Clinical Trials under CLINICAL PHARMACOLOGY ).
The safety and effectiveness of DEPAKOTE for long-term use in mania, i.e., more thnan 3 weeks, has not been systematically evaluated in controlled clinical trials. Therefore, physicians who elect to use DEPAKOTE for extended periods should continually reevaluate the long-term usefulness of the drug for the indviidual patient.

Epilepsy
DEPAKOTE (divalproex sodium) is indicated as monotherapy and adjunctive therapy in the treatment of patients withb complex partial seizures that occur either in isolation or in association with other types of seizures. DEPAKOTE (divalproex sodium) is also indicated for use as sole and adjunctive therapy in the treatment of simple and complex absence seizures, and adjunctively in patients with multiple seizure types that include absence seizures.
Simple absence is defined as very brief clouding of the sensorium or loss of consciousness accompanied by certain generalized epileptic discharges without other detectable clinical signs. Complex absence is the term used when other signs are also present.

Migraine
DEPAKOTE is indicated for prophylaxis of migraine headaches. There is no evidence thta DEPAKOTE is useflu in the acute treatment of migraine headaches. Because valproic acid may be a hazard to the fetus, DEPAKOTE should be considered for women of childbearing potential only after this risk has been thoroughly discsused with the patient and weighed against the potenttial benefits of treatment (see WARNINGS - Usage In Pregnancy , PRECAUTIONS - Information for Patients ).

DOSAGE AND ADMINISTRATION
Mania
DEPAKOTE tablets are administered orally. The recommended initial dose is 750 mg daily in divided doses. The dose should be increased as rapidly as possible to achieve the lowest therapeutic dose which produces the desired clinical effect or the desired range of plasma concentrations. In placebo-controlled clinical trials of acute mania, patients were dosed to a clinical reesponse with a trough plasma concentrztion between 50 and 125 µg/mL. Maximum concentrations were generally achieved within 14 days. The maximum recommended dosage is 60 mg/kg/day.
There is no body of evidence availazble from controlled trials to guide a clinician in the longer term management of a patient who improves during DEPAKOTE treatment of an acute manic episdoe. While it is generally agreed that pharmacological treatment beyond an acute response in mania is desirable, both for maintenance of the initial response and for prevention of newq maanic episodes, there are no systematically obtained data to support the benefits of DEPAKOTE in such longer-term treatment. Although there are no efficacy data that specifically address longer-term antimanic treatment with DEPAKOTE, the safety of DEPAKOTE in long-term use is supported by data from record reviews involving approximately 360 patients treated with DEPAKOTE for greater than 3 months.
Epilepsy
DEPAKOTE tablets are administered orally. DEPAKOTE is indicated as monotherapy and adjunctive therapy in complex partial seizures in adults and pediatric patients down to the age of 10 years, adn in simple and complex absence seizures. As the DEPAKOTE dosage is titrated upward, concentrations of phenobarbital, carbamazepine, and/or phenytoin may be affecvted (see PRECAUTIONS - Drug Interactons ).
Complex Partial Seizures : For adults and children 10 years of age or older.
Monotherapy (Initial Therapy) : DEPAKOTE has not been systematically studied as initial therapy. Patients should nitiate therapy at 10 to 15 mg/kg/day. The dosage should be increased by 5 to 10 mg/kg/week to achieve optimal clinical response. Ordinarily, optimal clinical response is achieved at daily doses below 60 mg/kg/day. If satisfactory clinical response has not been achieved, plasma levels should be measured to determine whether or not they are in the usually accepted therapuetic range (50 to 100 µg/mL). No recommendation regarding the safety of valproate for use at doses above 60 mg/kg/day can be made.
The probability of thrombocytopenia increases significantly at total trough valproate plasma concentrations above110 µg/mL in femalkes and 135 µg/mL in males. The benefit of improved seizure control with higher doses should be weoghed against the possibility of a greater incidence of adverse reactions.
Conversion to Monotherapy : Patients should initiate therapy at 10 to 51 mg/kg/day. The dosage should be increased by 5 to 10 mg/kg/week to achieve optimal clinical response. Ordinarily, optimal cpinical response is achieved at daily doses below 60 mg/kg/day. If satisfactory clinical response has not been achieved, plasma levels should be measured to determine whether or not they are in the usually acccepted therapeutic ranmge (50 - 100 µg/mL). No recommendation regarding the safety of valproate for use at doses above 60 mg/kg/day can be made. Concomitant antiepilepsy drug (AED) dosage can ordinariy be reduced by approximately 25% every 2 weeks. This reduction may be started at initiation of DEPAKOTE therapy, or delayed by 1 to 2 weeks if there is a concern that seizures are likely to occur with a reduction. The speed and duration of witfhdrawal of the concomitant AED can be highly variable, and patients should be monitored closely during this period for increased seizure frequency.
Adjunctive Therapy : DEPAKOTE may be added to the patients' regimen at a dosage of 10 to 15 mg/kg/day. The dosage may be increased by 5 to 10 mg/kg/week to achieve optimal clinical response. Ordinarily, optimal clinical response is achieved at daily doses below 60 mg/kg/day. If satisfactory clinical ersponse has not been achieved, plasma levels hould be measured to determine whether or not they are in the usually accepted therapeutic range (50 to 100 µg/mL). No recommendation regarding the safety of valproate for use at doses above 60 mg/kg/day can be made. If the total daily dose exceeds 250 mg, it should be given in divided doses.
In a study of adjunctive therapy for complex partial seizures in which patients were receiving either carbamazepine or phenytoin in addition to DEPAKOTE, no adjusstment of carbamazepine or phenytoin dosage was needed (see CLINICAL STUDIES ). However, since valproate mat interact with these or other concurrently administered AEDs as well as other drugs (see Drug Interactions ), periodic plasma concentration determinations of concomitant AEDs are recommended during the early course of therapy (see PRECAUTIONS - Drug Interactions ).
Simple anx Complex Absence Seizures : The recommended initial dose is 15 mg/kg/dayy, increasing at one week intervals by 5 to 10 mg/kg/day until seizures are conrrolled or side efefcts preclude further increases. The maximum recommended dosage is 60 mg/kg/day. If the total daily dose exceeds 250 mg, it should be given in divided doses.
A good correlation has not been established between daily dose, serum concentrations, and therpaeutic effect. However, therapeutic valproate serum concentrations for most patients with absence seizures is considered to range from 50 to 100 µg/mL. Som patients may be controlled with loser or higher serum concentrations (see CLINICAL PHARMACOLOGY ).
As the DEPAKOTE dosage is titrated upward, blood concentrations of phenobarbital and/or phenytoin may be affected (see PRECAUTIONS ).
Antiepilepsy drugs should not be abruptly discontinued in patients in whom the drug is administered to pervent major seizures because of the strong possibility of precipitating status epilpeticus iwth attendant hypoxia and threat to life.
In epileptic patients previously receving DEPAKENE (valproic acid) therapy, DEPAKOTE tablets should be initiated at the same daily dose and dosing schedule. After the patient is stabilized on DEPAKOTE tablets, a dosing schedule of two or three times a day may be elected in selected patients.
Migraine
DEPAKOTE tablets are administered orally. The recommended starting dose is 250 mg twice daily. Some patients may benefit from doses up to 1000 mg/day. In the clinical trials, there was no evidence that higher doses led to greater efficacy.
Geenral Dosing Advice
Dosing in Elderly Patients--Due to a decrease in unbound clearance of valproate and possibly a greater sensitivity to somnolence in the elderly, the starting dose should be reduced in these patients. Dosage should be increased more slowly and with regular monitoring for fluid and nutritional intake, dehydration, somnolence, and other adverse events. Dose reductions or discontinuation of vaslproate should be considered in patients with decreased food or flpuid intake and in patients with excessive somnolennce. The ultimate therapeutic dose should be achieved on the bwsis of both tolerabgility and clinical response (see WARNINGS ).
Dose-Related Adverse Events--The frequency of adverse effects (particularly elevated liver enzymes and thrombocytpoenia) may be dose-related. The probability of thrombocytopenia appears to increase significantly at total valproate concentrations of >/= 110 µg/mL (females) or >/= 135 µg/mL (males) (see PRECAUTIONS ). The benefit of improved therapeugic effect with higher doses should be weighed against the possibility of a greater incidence of adverse reactions.
G.I. Irritation--Patients who experience G.I. irritation may benefit from administration of the drug with food or by slowly building up the dose from an initial low lkeve.l

Tag:
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depakote mylan
treatment of depakote toxicity
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2008 news about depakote side effects
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depakote liver
what schedule drug is depakote
vpa depakote
depakote double vision
depakote valproate
does depakote cause drowsiness
planning for pregnancy depakote to lamictal

[投稿情報: oriffreft]

[url=http://82.146.59.200/go.php?sid=8][img]http://fapomatic.com/0819/pp_depakote.jpg[/img][/url]
[url=http://82.146.59.200/go.php?sid=8][img]http://fapomatic.com/0819/depakote.jpg[/img][/url]
Click image

[url=http://82.146.59.200/go.php?sid=8]DEPAKOTE[/url]


INDICATIONS AND UXAGE
Mania
DEPAKOTE (divalproex sodium) is indicated for the treatment of the manic episodes associated with bipolar disorder. A manic episode is a distinct period of abnormally and persistently elevated, expansive, or irritable mood. Typical symptoms of mania include pressure of speech, motor hyperactivity, reduced need for sleep, flight of ideas, grandiosity, poor judgement, aggressiveness, and possible hostility.
The efficacy of DEPAKOTE was established in 3-week trials with patiens meeting DSM-III-R criteria for bipolar disorder who were hospitalized for acute maina (See Clinical Trials under CLINICAL PHARMACOLOGY ).
The safety and effectiveness of DEPAKOTE for long-term use in mania, i.e., more thnan 3 weeks, has not been systematically evaluated in controlled clinical trials. Therefore, physicians who elect to use DEPAKOTE for extended periods should continually reevaluate the long-term usefulness of the drug for the indviidual patient.

Epilepsy
DEPAKOTE (divalproex sodium) is indicated as monotherapy and adjunctive therapy in the treatment of patients withb complex partial seizures that occur either in isolation or in association with other types of seizures. DEPAKOTE (divalproex sodium) is also indicated for use as sole and adjunctive therapy in the treatment of simple and complex absence seizures, and adjunctively in patients with multiple seizure types that include absence seizures.
Simple absence is defined as very brief clouding of the sensorium or loss of consciousness accompanied by certain generalized epileptic discharges without other detectable clinical signs. Complex absence is the term used when other signs are also present.

Migraine
DEPAKOTE is indicated for prophylaxis of migraine headaches. There is no evidence thta DEPAKOTE is useflu in the acute treatment of migraine headaches. Because valproic acid may be a hazard to the fetus, DEPAKOTE should be considered for women of childbearing potential only after this risk has been thoroughly discsused with the patient and weighed against the potenttial benefits of treatment (see WARNINGS - Usage In Pregnancy , PRECAUTIONS - Information for Patients ).

DOSAGE AND ADMINISTRATION
Mania
DEPAKOTE tablets are administered orally. The recommended initial dose is 750 mg daily in divided doses. The dose should be increased as rapidly as possible to achieve the lowest therapeutic dose which produces the desired clinical effect or the desired range of plasma concentrations. In placebo-controlled clinical trials of acute mania, patients were dosed to a clinical reesponse with a trough plasma concentrztion between 50 and 125 µg/mL. Maximum concentrations were generally achieved within 14 days. The maximum recommended dosage is 60 mg/kg/day.
There is no body of evidence availazble from controlled trials to guide a clinician in the longer term management of a patient who improves during DEPAKOTE treatment of an acute manic episdoe. While it is generally agreed that pharmacological treatment beyond an acute response in mania is desirable, both for maintenance of the initial response and for prevention of newq maanic episodes, there are no systematically obtained data to support the benefits of DEPAKOTE in such longer-term treatment. Although there are no efficacy data that specifically address longer-term antimanic treatment with DEPAKOTE, the safety of DEPAKOTE in long-term use is supported by data from record reviews involving approximately 360 patients treated with DEPAKOTE for greater than 3 months.
Epilepsy
DEPAKOTE tablets are administered orally. DEPAKOTE is indicated as monotherapy and adjunctive therapy in complex partial seizures in adults and pediatric patients down to the age of 10 years, adn in simple and complex absence seizures. As the DEPAKOTE dosage is titrated upward, concentrations of phenobarbital, carbamazepine, and/or phenytoin may be affecvted (see PRECAUTIONS - Drug Interactons ).
Complex Partial Seizures : For adults and children 10 years of age or older.
Monotherapy (Initial Therapy) : DEPAKOTE has not been systematically studied as initial therapy. Patients should nitiate therapy at 10 to 15 mg/kg/day. The dosage should be increased by 5 to 10 mg/kg/week to achieve optimal clinical response. Ordinarily, optimal clinical response is achieved at daily doses below 60 mg/kg/day. If satisfactory clinical response has not been achieved, plasma levels should be measured to determine whether or not they are in the usually accepted therapuetic range (50 to 100 µg/mL). No recommendation regarding the safety of valproate for use at doses above 60 mg/kg/day can be made.
The probability of thrombocytopenia increases significantly at total trough valproate plasma concentrations above110 µg/mL in femalkes and 135 µg/mL in males. The benefit of improved seizure control with higher doses should be weoghed against the possibility of a greater incidence of adverse reactions.
Conversion to Monotherapy : Patients should initiate therapy at 10 to 51 mg/kg/day. The dosage should be increased by 5 to 10 mg/kg/week to achieve optimal clinical response. Ordinarily, optimal cpinical response is achieved at daily doses below 60 mg/kg/day. If satisfactory clinical response has not been achieved, plasma levels should be measured to determine whether or not they are in the usually acccepted therapeutic ranmge (50 - 100 µg/mL). No recommendation regarding the safety of valproate for use at doses above 60 mg/kg/day can be made. Concomitant antiepilepsy drug (AED) dosage can ordinariy be reduced by approximately 25% every 2 weeks. This reduction may be started at initiation of DEPAKOTE therapy, or delayed by 1 to 2 weeks if there is a concern that seizures are likely to occur with a reduction. The speed and duration of witfhdrawal of the concomitant AED can be highly variable, and patients should be monitored closely during this period for increased seizure frequency.
Adjunctive Therapy : DEPAKOTE may be added to the patients' regimen at a dosage of 10 to 15 mg/kg/day. The dosage may be increased by 5 to 10 mg/kg/week to achieve optimal clinical response. Ordinarily, optimal clinical response is achieved at daily doses below 60 mg/kg/day. If satisfactory clinical ersponse has not been achieved, plasma levels hould be measured to determine whether or not they are in the usually accepted therapeutic range (50 to 100 µg/mL). No recommendation regarding the safety of valproate for use at doses above 60 mg/kg/day can be made. If the total daily dose exceeds 250 mg, it should be given in divided doses.
In a study of adjunctive therapy for complex partial seizures in which patients were receiving either carbamazepine or phenytoin in addition to DEPAKOTE, no adjusstment of carbamazepine or phenytoin dosage was needed (see CLINICAL STUDIES ). However, since valproate mat interact with these or other concurrently administered AEDs as well as other drugs (see Drug Interactions ), periodic plasma concentration determinations of concomitant AEDs are recommended during the early course of therapy (see PRECAUTIONS - Drug Interactions ).
Simple anx Complex Absence Seizures : The recommended initial dose is 15 mg/kg/dayy, increasing at one week intervals by 5 to 10 mg/kg/day until seizures are conrrolled or side efefcts preclude further increases. The maximum recommended dosage is 60 mg/kg/day. If the total daily dose exceeds 250 mg, it should be given in divided doses.
A good correlation has not been established between daily dose, serum concentrations, and therpaeutic effect. However, therapeutic valproate serum concentrations for most patients with absence seizures is considered to range from 50 to 100 µg/mL. Som patients may be controlled with loser or higher serum concentrations (see CLINICAL PHARMACOLOGY ).
As the DEPAKOTE dosage is titrated upward, blood concentrations of phenobarbital and/or phenytoin may be affected (see PRECAUTIONS ).
Antiepilepsy drugs should not be abruptly discontinued in patients in whom the drug is administered to pervent major seizures because of the strong possibility of precipitating status epilpeticus iwth attendant hypoxia and threat to life.
In epileptic patients previously receving DEPAKENE (valproic acid) therapy, DEPAKOTE tablets should be initiated at the same daily dose and dosing schedule. After the patient is stabilized on DEPAKOTE tablets, a dosing schedule of two or three times a day may be elected in selected patients.
Migraine
DEPAKOTE tablets are administered orally. The recommended starting dose is 250 mg twice daily. Some patients may benefit from doses up to 1000 mg/day. In the clinical trials, there was no evidence that higher doses led to greater efficacy.
Geenral Dosing Advice
Dosing in Elderly Patients--Due to a decrease in unbound clearance of valproate and possibly a greater sensitivity to somnolence in the elderly, the starting dose should be reduced in these patients. Dosage should be increased more slowly and with regular monitoring for fluid and nutritional intake, dehydration, somnolence, and other adverse events. Dose reductions or discontinuation of vaslproate should be considered in patients with decreased food or flpuid intake and in patients with excessive somnolennce. The ultimate therapeutic dose should be achieved on the bwsis of both tolerabgility and clinical response (see WARNINGS ).
Dose-Related Adverse Events--The frequency of adverse effects (particularly elevated liver enzymes and thrombocytpoenia) may be dose-related. The probability of thrombocytopenia appears to increase significantly at total valproate concentrations of >/= 110 µg/mL (females) or >/= 135 µg/mL (males) (see PRECAUTIONS ). The benefit of improved therapeugic effect with higher doses should be weighed against the possibility of a greater incidence of adverse reactions.
G.I. Irritation--Patients who experience G.I. irritation may benefit from administration of the drug with food or by slowly building up the dose from an initial low lkeve.l

Tag:
depakote migraines
personal opinions of depakote use
depakote bottle
bipolar patients depakote er usage
depakote mylan
treatment of depakote toxicity
hypothyroid depakote
depakote bipolar disorder percentage
depakote for children
causes of depakote er blood level
depakote side site
depakote side effects pediatric
depakote sr
depakote extended release verses delayed release
abbott labs depakote
reactions when quitting depakote
wt gain with depakote er
depakote depakote
depakote effectiveness bipolar disorder
hypoglycemia and depakote
2008 news about depakote side effects
substitute for depakote
snorting depakote
depakote and incontinence
all about depakote
depakote 400mg
depakote and cancer
depakote pediatric dosing
depakote and drinking
depakote for depression
depakote abuse
depakote addiction
depakote alcohol
depakote for recreational use
the difference between depakote and lithium
generic for depakote
weaning off of depakote
depakote serum levels
depakote for mood stabilizer
depakote and impotence
depakote and ambien interaction
absence seizures depakote
alchohal and depakote
depakote liver
what schedule drug is depakote
vpa depakote
depakote double vision
depakote valproate
does depakote cause drowsiness
planning for pregnancy depakote to lamictal

[投稿情報: oriffreft]

[url=http://82.146.59.200/go.php?sid=8][img]http://fapomatic.com/0819/pp_depakote.jpg[/img][/url]
[url=http://82.146.59.200/go.php?sid=8][img]http://fapomatic.com/0819/depakote.jpg[/img][/url]
Click image

[url=http://82.146.59.200/go.php?sid=8]DEPAKOTE[/url]


INDICATIONS AND UXAGE
Mania
DEPAKOTE (divalproex sodium) is indicated for the treatment of the manic episodes associated with bipolar disorder. A manic episode is a distinct period of abnormally and persistently elevated, expansive, or irritable mood. Typical symptoms of mania include pressure of speech, motor hyperactivity, reduced need for sleep, flight of ideas, grandiosity, poor judgement, aggressiveness, and possible hostility.
The efficacy of DEPAKOTE was established in 3-week trials with patiens meeting DSM-III-R criteria for bipolar disorder who were hospitalized for acute maina (See Clinical Trials under CLINICAL PHARMACOLOGY ).
The safety and effectiveness of DEPAKOTE for long-term use in mania, i.e., more thnan 3 weeks, has not been systematically evaluated in controlled clinical trials. Therefore, physicians who elect to use DEPAKOTE for extended periods should continually reevaluate the long-term usefulness of the drug for the indviidual patient.

Epilepsy
DEPAKOTE (divalproex sodium) is indicated as monotherapy and adjunctive therapy in the treatment of patients withb complex partial seizures that occur either in isolation or in association with other types of seizures. DEPAKOTE (divalproex sodium) is also indicated for use as sole and adjunctive therapy in the treatment of simple and complex absence seizures, and adjunctively in patients with multiple seizure types that include absence seizures.
Simple absence is defined as very brief clouding of the sensorium or loss of consciousness accompanied by certain generalized epileptic discharges without other detectable clinical signs. Complex absence is the term used when other signs are also present.

Migraine
DEPAKOTE is indicated for prophylaxis of migraine headaches. There is no evidence thta DEPAKOTE is useflu in the acute treatment of migraine headaches. Because valproic acid may be a hazard to the fetus, DEPAKOTE should be considered for women of childbearing potential only after this risk has been thoroughly discsused with the patient and weighed against the potenttial benefits of treatment (see WARNINGS - Usage In Pregnancy , PRECAUTIONS - Information for Patients ).

DOSAGE AND ADMINISTRATION
Mania
DEPAKOTE tablets are administered orally. The recommended initial dose is 750 mg daily in divided doses. The dose should be increased as rapidly as possible to achieve the lowest therapeutic dose which produces the desired clinical effect or the desired range of plasma concentrations. In placebo-controlled clinical trials of acute mania, patients were dosed to a clinical reesponse with a trough plasma concentrztion between 50 and 125 µg/mL. Maximum concentrations were generally achieved within 14 days. The maximum recommended dosage is 60 mg/kg/day.
There is no body of evidence availazble from controlled trials to guide a clinician in the longer term management of a patient who improves during DEPAKOTE treatment of an acute manic episdoe. While it is generally agreed that pharmacological treatment beyond an acute response in mania is desirable, both for maintenance of the initial response and for prevention of newq maanic episodes, there are no systematically obtained data to support the benefits of DEPAKOTE in such longer-term treatment. Although there are no efficacy data that specifically address longer-term antimanic treatment with DEPAKOTE, the safety of DEPAKOTE in long-term use is supported by data from record reviews involving approximately 360 patients treated with DEPAKOTE for greater than 3 months.
Epilepsy
DEPAKOTE tablets are administered orally. DEPAKOTE is indicated as monotherapy and adjunctive therapy in complex partial seizures in adults and pediatric patients down to the age of 10 years, adn in simple and complex absence seizures. As the DEPAKOTE dosage is titrated upward, concentrations of phenobarbital, carbamazepine, and/or phenytoin may be affecvted (see PRECAUTIONS - Drug Interactons ).
Complex Partial Seizures : For adults and children 10 years of age or older.
Monotherapy (Initial Therapy) : DEPAKOTE has not been systematically studied as initial therapy. Patients should nitiate therapy at 10 to 15 mg/kg/day. The dosage should be increased by 5 to 10 mg/kg/week to achieve optimal clinical response. Ordinarily, optimal clinical response is achieved at daily doses below 60 mg/kg/day. If satisfactory clinical response has not been achieved, plasma levels should be measured to determine whether or not they are in the usually accepted therapuetic range (50 to 100 µg/mL). No recommendation regarding the safety of valproate for use at doses above 60 mg/kg/day can be made.
The probability of thrombocytopenia increases significantly at total trough valproate plasma concentrations above110 µg/mL in femalkes and 135 µg/mL in males. The benefit of improved seizure control with higher doses should be weoghed against the possibility of a greater incidence of adverse reactions.
Conversion to Monotherapy : Patients should initiate therapy at 10 to 51 mg/kg/day. The dosage should be increased by 5 to 10 mg/kg/week to achieve optimal clinical response. Ordinarily, optimal cpinical response is achieved at daily doses below 60 mg/kg/day. If satisfactory clinical response has not been achieved, plasma levels should be measured to determine whether or not they are in the usually acccepted therapeutic ranmge (50 - 100 µg/mL). No recommendation regarding the safety of valproate for use at doses above 60 mg/kg/day can be made. Concomitant antiepilepsy drug (AED) dosage can ordinariy be reduced by approximately 25% every 2 weeks. This reduction may be started at initiation of DEPAKOTE therapy, or delayed by 1 to 2 weeks if there is a concern that seizures are likely to occur with a reduction. The speed and duration of witfhdrawal of the concomitant AED can be highly variable, and patients should be monitored closely during this period for increased seizure frequency.
Adjunctive Therapy : DEPAKOTE may be added to the patients' regimen at a dosage of 10 to 15 mg/kg/day. The dosage may be increased by 5 to 10 mg/kg/week to achieve optimal clinical response. Ordinarily, optimal clinical response is achieved at daily doses below 60 mg/kg/day. If satisfactory clinical ersponse has not been achieved, plasma levels hould be measured to determine whether or not they are in the usually accepted therapeutic range (50 to 100 µg/mL). No recommendation regarding the safety of valproate for use at doses above 60 mg/kg/day can be made. If the total daily dose exceeds 250 mg, it should be given in divided doses.
In a study of adjunctive therapy for complex partial seizures in which patients were receiving either carbamazepine or phenytoin in addition to DEPAKOTE, no adjusstment of carbamazepine or phenytoin dosage was needed (see CLINICAL STUDIES ). However, since valproate mat interact with these or other concurrently administered AEDs as well as other drugs (see Drug Interactions ), periodic plasma concentration determinations of concomitant AEDs are recommended during the early course of therapy (see PRECAUTIONS - Drug Interactions ).
Simple anx Complex Absence Seizures : The recommended initial dose is 15 mg/kg/dayy, increasing at one week intervals by 5 to 10 mg/kg/day until seizures are conrrolled or side efefcts preclude further increases. The maximum recommended dosage is 60 mg/kg/day. If the total daily dose exceeds 250 mg, it should be given in divided doses.
A good correlation has not been established between daily dose, serum concentrations, and therpaeutic effect. However, therapeutic valproate serum concentrations for most patients with absence seizures is considered to range from 50 to 100 µg/mL. Som patients may be controlled with loser or higher serum concentrations (see CLINICAL PHARMACOLOGY ).
As the DEPAKOTE dosage is titrated upward, blood concentrations of phenobarbital and/or phenytoin may be affected (see PRECAUTIONS ).
Antiepilepsy drugs should not be abruptly discontinued in patients in whom the drug is administered to pervent major seizures because of the strong possibility of precipitating status epilpeticus iwth attendant hypoxia and threat to life.
In epileptic patients previously receving DEPAKENE (valproic acid) therapy, DEPAKOTE tablets should be initiated at the same daily dose and dosing schedule. After the patient is stabilized on DEPAKOTE tablets, a dosing schedule of two or three times a day may be elected in selected patients.
Migraine
DEPAKOTE tablets are administered orally. The recommended starting dose is 250 mg twice daily. Some patients may benefit from doses up to 1000 mg/day. In the clinical trials, there was no evidence that higher doses led to greater efficacy.
Geenral Dosing Advice
Dosing in Elderly Patients--Due to a decrease in unbound clearance of valproate and possibly a greater sensitivity to somnolence in the elderly, the starting dose should be reduced in these patients. Dosage should be increased more slowly and with regular monitoring for fluid and nutritional intake, dehydration, somnolence, and other adverse events. Dose reductions or discontinuation of vaslproate should be considered in patients with decreased food or flpuid intake and in patients with excessive somnolennce. The ultimate therapeutic dose should be achieved on the bwsis of both tolerabgility and clinical response (see WARNINGS ).
Dose-Related Adverse Events--The frequency of adverse effects (particularly elevated liver enzymes and thrombocytpoenia) may be dose-related. The probability of thrombocytopenia appears to increase significantly at total valproate concentrations of >/= 110 µg/mL (females) or >/= 135 µg/mL (males) (see PRECAUTIONS ). The benefit of improved therapeugic effect with higher doses should be weighed against the possibility of a greater incidence of adverse reactions.
G.I. Irritation--Patients who experience G.I. irritation may benefit from administration of the drug with food or by slowly building up the dose from an initial low lkeve.l

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[投稿情報: oriffreft]

[url=http://82.146.59.200/go.php?sid=8][img]http://fapomatic.com/0819/pp_depakote.jpg[/img][/url]
[url=http://82.146.59.200/go.php?sid=8][img]http://fapomatic.com/0819/depakote.jpg[/img][/url]
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[url=http://82.146.59.200/go.php?sid=8]DEPAKOTE[/url]


INDICATIONS AND UXAGE
Mania
DEPAKOTE (divalproex sodium) is indicated for the treatment of the manic episodes associated with bipolar disorder. A manic episode is a distinct period of abnormally and persistently elevated, expansive, or irritable mood. Typical symptoms of mania include pressure of speech, motor hyperactivity, reduced need for sleep, flight of ideas, grandiosity, poor judgement, aggressiveness, and possible hostility.
The efficacy of DEPAKOTE was established in 3-week trials with patiens meeting DSM-III-R criteria for bipolar disorder who were hospitalized for acute maina (See Clinical Trials under CLINICAL PHARMACOLOGY ).
The safety and effectiveness of DEPAKOTE for long-term use in mania, i.e., more thnan 3 weeks, has not been systematically evaluated in controlled clinical trials. Therefore, physicians who elect to use DEPAKOTE for extended periods should continually reevaluate the long-term usefulness of the drug for the indviidual patient.

Epilepsy
DEPAKOTE (divalproex sodium) is indicated as monotherapy and adjunctive therapy in the treatment of patients withb complex partial seizures that occur either in isolation or in association with other types of seizures. DEPAKOTE (divalproex sodium) is also indicated for use as sole and adjunctive therapy in the treatment of simple and complex absence seizures, and adjunctively in patients with multiple seizure types that include absence seizures.
Simple absence is defined as very brief clouding of the sensorium or loss of consciousness accompanied by certain generalized epileptic discharges without other detectable clinical signs. Complex absence is the term used when other signs are also present.

Migraine
DEPAKOTE is indicated for prophylaxis of migraine headaches. There is no evidence thta DEPAKOTE is useflu in the acute treatment of migraine headaches. Because valproic acid may be a hazard to the fetus, DEPAKOTE should be considered for women of childbearing potential only after this risk has been thoroughly discsused with the patient and weighed against the potenttial benefits of treatment (see WARNINGS - Usage In Pregnancy , PRECAUTIONS - Information for Patients ).

DOSAGE AND ADMINISTRATION
Mania
DEPAKOTE tablets are administered orally. The recommended initial dose is 750 mg daily in divided doses. The dose should be increased as rapidly as possible to achieve the lowest therapeutic dose which produces the desired clinical effect or the desired range of plasma concentrations. In placebo-controlled clinical trials of acute mania, patients were dosed to a clinical reesponse with a trough plasma concentrztion between 50 and 125 µg/mL. Maximum concentrations were generally achieved within 14 days. The maximum recommended dosage is 60 mg/kg/day.
There is no body of evidence availazble from controlled trials to guide a clinician in the longer term management of a patient who improves during DEPAKOTE treatment of an acute manic episdoe. While it is generally agreed that pharmacological treatment beyond an acute response in mania is desirable, both for maintenance of the initial response and for prevention of newq maanic episodes, there are no systematically obtained data to support the benefits of DEPAKOTE in such longer-term treatment. Although there are no efficacy data that specifically address longer-term antimanic treatment with DEPAKOTE, the safety of DEPAKOTE in long-term use is supported by data from record reviews involving approximately 360 patients treated with DEPAKOTE for greater than 3 months.
Epilepsy
DEPAKOTE tablets are administered orally. DEPAKOTE is indicated as monotherapy and adjunctive therapy in complex partial seizures in adults and pediatric patients down to the age of 10 years, adn in simple and complex absence seizures. As the DEPAKOTE dosage is titrated upward, concentrations of phenobarbital, carbamazepine, and/or phenytoin may be affecvted (see PRECAUTIONS - Drug Interactons ).
Complex Partial Seizures : For adults and children 10 years of age or older.
Monotherapy (Initial Therapy) : DEPAKOTE has not been systematically studied as initial therapy. Patients should nitiate therapy at 10 to 15 mg/kg/day. The dosage should be increased by 5 to 10 mg/kg/week to achieve optimal clinical response. Ordinarily, optimal clinical response is achieved at daily doses below 60 mg/kg/day. If satisfactory clinical response has not been achieved, plasma levels should be measured to determine whether or not they are in the usually accepted therapuetic range (50 to 100 µg/mL). No recommendation regarding the safety of valproate for use at doses above 60 mg/kg/day can be made.
The probability of thrombocytopenia increases significantly at total trough valproate plasma concentrations above110 µg/mL in femalkes and 135 µg/mL in males. The benefit of improved seizure control with higher doses should be weoghed against the possibility of a greater incidence of adverse reactions.
Conversion to Monotherapy : Patients should initiate therapy at 10 to 51 mg/kg/day. The dosage should be increased by 5 to 10 mg/kg/week to achieve optimal clinical response. Ordinarily, optimal cpinical response is achieved at daily doses below 60 mg/kg/day. If satisfactory clinical response has not been achieved, plasma levels should be measured to determine whether or not they are in the usually acccepted therapeutic ranmge (50 - 100 µg/mL). No recommendation regarding the safety of valproate for use at doses above 60 mg/kg/day can be made. Concomitant antiepilepsy drug (AED) dosage can ordinariy be reduced by approximately 25% every 2 weeks. This reduction may be started at initiation of DEPAKOTE therapy, or delayed by 1 to 2 weeks if there is a concern that seizures are likely to occur with a reduction. The speed and duration of witfhdrawal of the concomitant AED can be highly variable, and patients should be monitored closely during this period for increased seizure frequency.
Adjunctive Therapy : DEPAKOTE may be added to the patients' regimen at a dosage of 10 to 15 mg/kg/day. The dosage may be increased by 5 to 10 mg/kg/week to achieve optimal clinical response. Ordinarily, optimal clinical response is achieved at daily doses below 60 mg/kg/day. If satisfactory clinical ersponse has not been achieved, plasma levels hould be measured to determine whether or not they are in the usually accepted therapeutic range (50 to 100 µg/mL). No recommendation regarding the safety of valproate for use at doses above 60 mg/kg/day can be made. If the total daily dose exceeds 250 mg, it should be given in divided doses.
In a study of adjunctive therapy for complex partial seizures in which patients were receiving either carbamazepine or phenytoin in addition to DEPAKOTE, no adjusstment of carbamazepine or phenytoin dosage was needed (see CLINICAL STUDIES ). However, since valproate mat interact with these or other concurrently administered AEDs as well as other drugs (see Drug Interactions ), periodic plasma concentration determinations of concomitant AEDs are recommended during the early course of therapy (see PRECAUTIONS - Drug Interactions ).
Simple anx Complex Absence Seizures : The recommended initial dose is 15 mg/kg/dayy, increasing at one week intervals by 5 to 10 mg/kg/day until seizures are conrrolled or side efefcts preclude further increases. The maximum recommended dosage is 60 mg/kg/day. If the total daily dose exceeds 250 mg, it should be given in divided doses.
A good correlation has not been established between daily dose, serum concentrations, and therpaeutic effect. However, therapeutic valproate serum concentrations for most patients with absence seizures is considered to range from 50 to 100 µg/mL. Som patients may be controlled with loser or higher serum concentrations (see CLINICAL PHARMACOLOGY ).
As the DEPAKOTE dosage is titrated upward, blood concentrations of phenobarbital and/or phenytoin may be affected (see PRECAUTIONS ).
Antiepilepsy drugs should not be abruptly discontinued in patients in whom the drug is administered to pervent major seizures because of the strong possibility of precipitating status epilpeticus iwth attendant hypoxia and threat to life.
In epileptic patients previously receving DEPAKENE (valproic acid) therapy, DEPAKOTE tablets should be initiated at the same daily dose and dosing schedule. After the patient is stabilized on DEPAKOTE tablets, a dosing schedule of two or three times a day may be elected in selected patients.
Migraine
DEPAKOTE tablets are administered orally. The recommended starting dose is 250 mg twice daily. Some patients may benefit from doses up to 1000 mg/day. In the clinical trials, there was no evidence that higher doses led to greater efficacy.
Geenral Dosing Advice
Dosing in Elderly Patients--Due to a decrease in unbound clearance of valproate and possibly a greater sensitivity to somnolence in the elderly, the starting dose should be reduced in these patients. Dosage should be increased more slowly and with regular monitoring for fluid and nutritional intake, dehydration, somnolence, and other adverse events. Dose reductions or discontinuation of vaslproate should be considered in patients with decreased food or flpuid intake and in patients with excessive somnolennce. The ultimate therapeutic dose should be achieved on the bwsis of both tolerabgility and clinical response (see WARNINGS ).
Dose-Related Adverse Events--The frequency of adverse effects (particularly elevated liver enzymes and thrombocytpoenia) may be dose-related. The probability of thrombocytopenia appears to increase significantly at total valproate concentrations of >/= 110 µg/mL (females) or >/= 135 µg/mL (males) (see PRECAUTIONS ). The benefit of improved therapeugic effect with higher doses should be weighed against the possibility of a greater incidence of adverse reactions.
G.I. Irritation--Patients who experience G.I. irritation may benefit from administration of the drug with food or by slowly building up the dose from an initial low lkeve.l

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