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Valproate in acute mania: is our practice evidence based?
Kamini Vasudev1, Anna Mead, Karine Macritchie
1London Health Sciences Centre, University of Western Ontario, London, Canada. kamini.vasudev@lhsc.on.ca
International Journal of Health Care Quality Assurance
|March 30, 2012
Summary
This audit found that valproate prescribing for acute mania often deviates from evidence-based guidelines, particularly regarding accelerated dosing. This suboptimal practice may impact treatment efficacy and prolong hospital stays for patients with mania.
Area of Science:
- Psychiatry
- Pharmacology
- Clinical Pharmacy
Background:
- Valproate is a key medication for managing acute mania.
- Evidence-based guidelines recommend specific dosing strategies for optimal efficacy.
- Current prescribing practices require evaluation against these guidelines.
Purpose of the Study:
- To audit valproate prescribing in acute psychiatric in-patient wards for acute mania.
- To assess adherence to evidence-based guidelines regarding valproate formulations and dosing.
- To determine the prevalence of accelerated valproate dosing in clinical practice.
Main Methods:
- A retrospective review of case notes for 43 patients admitted with mania and treated with valproate.
- Data collected included valproate formulation, weight, initial dose, dose increments, and serum level monitoring.
- Analysis focused on adherence to accelerated dosing protocols.
Main Results:
- Sodium valproate was the predominant formulation used (95%).
- Weight was recorded in only 9% of patients, hindering accelerated dosing calculations.
- The mean time to reach maximum valproate dose was 29 days, indicating a lack of accelerated dosing.
- A significant positive correlation was observed between the time to reach maximum dose and hospital stay duration.
Conclusions:
- Accelerated valproate dosing is not common practice in acute mania treatment.
- Current prescribing patterns may lead to suboptimal efficacy and necessitate combination treatments.
- The study underscores the need for improved adherence to guidelines for initial dosing and dose increments in manic patients.
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