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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by chip on March 19, 2001, at 15:22:49
I have been on an increased dosage of 1000 mg for
two weeks. Since the increase from 750 to 1000mg,
I have been very tired and drowsy. Will these side effects subside?
Posted by SalArmy4me on March 19, 2001, at 18:29:27
In reply to depakote and lack of energy, posted by chip on March 19, 2001, at 15:22:49
Maybe you could try Depakote ER.
> I have been on an increased dosage of 1000 mg for
> two weeks. Since the increase from 750 to 1000mg,
> I have been very tired and drowsy. Will these side effects subside?
Posted by Ted on March 19, 2001, at 23:42:43
In reply to depakote and lack of energy, posted by chip on March 19, 2001, at 15:22:49
Hi Chip,
I take Depakote 500 mg twice a day. Yes, I think most side effects go away after time.
Here are some tips:
0. Always take with meals. Never break tablets.
1. Take the first dose at lunchtime and the second dose at dinnertime for the first 3-4 months.
2. When you notice decreased drowsiness, switch to breakfast & dinner.
3. AVOID ALL ALCOHOL and caffeine. They will make you feel *much* worse.
4. Try to get exercise, the more the better. Lethargy is IMHO its worst side effect, and for me it hasnt diminished much in 2 years.
5. Make sure you get regular blood tests for the first couple of months now that you have increased your dose. Depakote can cause liver damage, so it is important to make sure everything is fine.
6. Depakote has a list of drug interactions, some of them serious, about a mile long. Study them and make sure you don't take any other meds that might exacerbate the problems.Take care, and good luck. Feel free to write anytime.
Ted
PS: In my personal opinion, Depakote ER is just a marketing gimmic. It really is no different from regular old depakote. Abbott Labs just needed another money maker.
> I have been on an increased dosage of 1000 mg for
> two weeks. Since the increase from 750 to 1000mg,
> I have been very tired and drowsy. Will these side effects subside?
Posted by sherry gomez on March 22, 2001, at 12:00:05
In reply to Re: depakote and lack of energy, posted by Ted on March 19, 2001, at 23:42:43
> Hi Chip,
>
> I take Depakote 500 mg twice a day. Yes, I think most side effects go away after time.
>
> Here are some tips:
>
> 0. Always take with meals. Never break tablets.
>
> 1. Take the first dose at lunchtime and the second dose at dinnertime for the first 3-4 months.
> 2. When you notice decreased drowsiness, switch to breakfast & dinner.
> 3. AVOID ALL ALCOHOL and caffeine. They will make you feel *much* worse.
> 4. Try to get exercise, the more the better. Lethargy is IMHO its worst side effect, and for me it hasnt diminished much in 2 years.
> 5. Make sure you get regular blood tests for the first couple of months now that you have increased your dose. Depakote can cause liver damage, so it is important to make sure everything is fine.
> 6. Depakote has a list of drug interactions, some of them serious, about a mile long. Study them and make sure you don't take any other meds that might exacerbate the problems.
>
> Take care, and good luck. Feel free to write anytime.
>
> Ted
>
> PS: In my personal opinion, Depakote ER is just a marketing gimmic. It really is no different from regular old depakote. Abbott Labs just needed another money maker.
>
>
>
> > I have been on an increased dosage of 1000 mg for
> > two weeks. Since the increase from 750 to 1000mg,
> > I have been very tired and drowsy. Will these side effects subside?>Ted, this is the best advise yet on depakote, I tried it and it helps alot.... I was told to take 1000mg at bedtime and 500mg in the morning and I had trouble staying awake at work
It does help with meals.... although I take Depakote ER... But I cant see any difference
Posted by Ted on March 22, 2001, at 13:44:39
In reply to Re: depakote and lack of energy, posted by sherry gomez on March 22, 2001, at 12:00:05
Sherry,
>Ted, this is the best advise yet on depakote, I tried it and it helps alot.... I was told to take 1000mg at bedtime and 500mg in the morning and I had trouble staying awake at work
>
> It does help with meals.... although I take Depakote ER... But I cant see any differenceThanks! Even still, I can fall asleep in the afternoon anytime. But I think it is important to try and avoid napping -- get all of your sleep in one spell at bedtime.
I don't think Depakote ER is any different from regular depakote. Regular depakote *is* extended release! It's all marketing!
Chip,
One thing I didn't make clear: Have regular blood tests always, not just because the dose was increased. Liver problems can pop up anytime, and you also need to make sure you don't take any more than you have to.
Ted
Posted by Sunnely on March 25, 2001, at 19:17:09
In reply to depakote and lack of energy, posted by chip on March 19, 2001, at 15:22:49
Hi Chip,
Have the following blood tests done:
1. Blood level of valproic acid (valproate)
2. Liver function tests (liver enzymes)
3. Blood ammonia level
4. Blood carnitine (total and free) levels
The "therapeutic" blood level of valproic acid for bipolar disorder is between 50-125 ug/ml (microgram per milliliter). Of course, as the dose is increased, the blood level also increases. Except for transient increases in symptoms (e.g., fatigue, drowsiness), blood levels between these levels are generally tolerated. However, there are some people who do experience distressing side effects even within these range of blood levels.
2. Although not common in adults, Depakote can induce hepatotoxicity (liver toxicity). Extreme fatigue and drowsiness, especially if accompanied by gastrointestinal symptoms such as anorexia (lack of appetite) and right upper (abdominal) quadrant pain, may point to liver problem.
3. Marked fatigue and drowsiness, especially if accompanied by mental confusion may point to an elevated blood level of ammonia. Depakote can impair ammonia clearance. Blood ammonia level can be elevated despite normal levels of liver enzymes.
4. Similar to elevated blood ammonia, marked fatigue and drowsiness may be indicative of carnitine deficiency. Some people are born with a defect in the enzyme that forms carnitine. People with this enzyme deficiency can develop marked fatigue and drowsiness when given Depakote. Giving Carnitor (levo-carnitine) can prevent this from occurring.
+++++++++++++++++++++++++++++++++++++++++++++
> I have been on an increased dosage of 1000 mg for
> two weeks. Since the increase from 750 to 1000mg,
> I have been very tired and drowsy. Will these side effects subside?
Posted by chip on March 27, 2001, at 12:11:51
In reply to Re: depakote and lack of energy » chip, posted by Sunnely on March 25, 2001, at 19:17:09
> Hi Chip,
>
> Have the following blood tests done:
>
> 1. Blood level of valproic acid (valproate)
>
> 2. Liver function tests (liver enzymes)
>
> 3. Blood ammonia level
>
> 4. Blood carnitine (total and free) levels
>
> The "therapeutic" blood level of valproic acid for bipolar disorder is between 50-125 ug/ml (microgram per milliliter). Of course, as the dose is increased, the blood level also increases. Except for transient increases in symptoms (e.g., fatigue, drowsiness), blood levels between these levels are generally tolerated. However, there are some people who do experience distressing side effects even within these range of blood levels.
>
> 2. Although not common in adults, Depakote can induce hepatotoxicity (liver toxicity). Extreme fatigue and drowsiness, especially if accompanied by gastrointestinal symptoms such as anorexia (lack of appetite) and right upper (abdominal) quadrant pain, may point to liver problem.
>
> 3. Marked fatigue and drowsiness, especially if accompanied by mental confusion may point to an elevated blood level of ammonia. Depakote can impair ammonia clearance. Blood ammonia level can be elevated despite normal levels of liver enzymes.
>
> 4. Similar to elevated blood ammonia, marked fatigue and drowsiness may be indicative of carnitine deficiency. Some people are born with a defect in the enzyme that forms carnitine. People with this enzyme deficiency can develop marked fatigue and drowsiness when given Depakote. Giving Carnitor (levo-carnitine) can prevent this from occurring.
>
> +++++++++++++++++++++++++++++++++++++++++++++
>
> > I have been on an increased dosage of 1000 mg for
> > two weeks. Since the increase from 750 to 1000mg,
> > I have been very tired and drowsy. Will these side effects subside?thank you everyone for the good information
Posted by sherry gomez on March 31, 2001, at 12:44:18
In reply to Re: depakote and lack of energy » Sunnely, posted by chip on March 27, 2001, at 12:11:51
> > Hi Chip,
> >
> > Have the following blood tests done:
> >
> > 1. Blood level of valproic acid (valproate)
> >
> > 2. Liver function tests (liver enzymes)
> >
> > 3. Blood ammonia level
> >
> > 4. Blood carnitine (total and free) levels
> >
> > The "therapeutic" blood level of valproic acid for bipolar disorder is between 50-125 ug/ml (microgram per milliliter). Of course, as the dose is increased, the blood level also increases. Except for transient increases in symptoms (e.g., fatigue, drowsiness), blood levels between these levels are generally tolerated. However, there are some people who do experience distressing side effects even within these range of blood levels.
> >
> > 2. Although not common in adults, Depakote can induce hepatotoxicity (liver toxicity). Extreme fatigue and drowsiness, especially if accompanied by gastrointestinal symptoms such as anorexia (lack of appetite) and right upper (abdominal) quadrant pain, may point to liver problem.
> >
> > 3. Marked fatigue and drowsiness, especially if accompanied by mental confusion may point to an elevated blood level of ammonia. Depakote can impair ammonia clearance. Blood ammonia level can be elevated despite normal levels of liver enzymes.
> >
> > 4. Similar to elevated blood ammonia, marked fatigue and drowsiness may be indicative of carnitine deficiency. Some people are born with a defect in the enzyme that forms carnitine. People with this enzyme deficiency can develop marked fatigue and drowsiness when given Depakote. Giving Carnitor (levo-carnitine) can prevent this from occurring.
> >
> > +++++++++++++++++++++++++++++++++++++++++++++
> >
> > > I have been on an increased dosage of 1000 mg for
> > > two weeks. Since the increase from 750 to 1000mg,
> > > I have been very tired and drowsy. Will these side effects subside?
>
> thank you everyone for the good information>Chip, you have givin us such great info...
although I just cant seem to stay awake
I seen my pdoc and he thinks I am doing good and I dont have to see him for 3months which is good for me... I asked for a liver test so next week I am getting.. I take 1500 mg of depakote without a liver and blood test...
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