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Excerpt 2
James W. Jefferson, MD and John H. Greist, MD

Divalproex & Bipolar Disorder: A Guide

(Excerpt 2)

How should divalproex be taken? A doctor familiar with divalproex use is best able to determine how much divalproex is needed and how often it should be taken. Since the proper dose varies among individuals, patients are advised to follow the directions on the prescription label. They should never hesitate, however, to ask their doctor or pharmacist any question about dosage directions. To minimize side effects, doctors will often start new patients on a low dose and gradually increase it until the desired effect is obtained. Later, the dose may again be adjusted with the goal of finding the "minimal effective dose" (i.e., the least amount of drug needed to obtain the desired effect). Sometimes a higher starting dose (also known as a loading dose) will be used with the goal of getting a more rapid onset of action.

Divalproex is usually taken in two or three divided doses over the course of the day (for example, 250 mg of divalproex [Depakote] three times daily). There is some evidence that divalproex may be effective and tolerated when taken once daily, but whether to do so should be determined by the doctor.

Taking divalproex regularly as prescribed is important, and people must work out ways to avoid forgetting doses and/or taking extra doses. Taking less than the prescribed amount may not be effective, while taking more may make a person sick from side effects. A pill container with seven compartments designed to hold a week�s supply of pills will help avoid these problems.

To prevent any interruption in treatment, the pharmacy should be contacted for a prescription refill several days before running out of medication. Experience has shown that patients may ignore their divalproex treatment when they are feeling better and sometimes delay obtaining refills or stop taking divalproex altogether. By doing so they deprive themselves of the "protective insurance" that divalproex provides against future episodes of severe mood disorder.

Many people prefer to take their medication with meals, which not only helps them remember to take it but also helps to avoid nausea that sometimes occurs if it is taken on an empty stomach. It is not necessary, however, to take divalproex with food.