Q:  Reducing Depakote Levels-Is This Reasonable?

Dear Dr. Phelps,
Recently I had a blood test and my depakote level was 119.  I take 1500 mg of depakote.  My doctor wants me to not take any depakote for two days and then go down to 500mg for 3 days, and then take another blood test.  Does this sound feasible to you?  Let me mention that I have problems with my kidneys and that is what he feels is causing the high level of depakote.

I would appreciate your advice on this matter I am concerned about going off the depakote and also cutting it to 500mg.

Thank you for your advice,


Dear Ms. C' -- 
As I've been working on some time-pressured projects lately, I'm late with my BPW letters, and I fear my response to your question may be coming rather too late. But the idea of lowering your Depakote in this fashion is not unheard of. Some might choose a taper that was more gradual, such as a period on three pills (1000 mg), and then stepping the rest of the way down.  However, the advice you were given makes it sound as though the doctor was in a hurry to lower your level.  If you were having some sort of side effect or bad outcome perhaps related to the Depakote, that might be important (and I hope you've done it by now, in that case!)  If your doctor was solely concerned about the level, however, you might ask him (perhaps using some of the ideas on my Talking with Doctors page) about having heard that in bipolar disorder treatment, using the range in most labs, levels up to 125 are acceptable (the top when treating epilepsy was, for years, just 100), so that the level alone would not indicate a need to lower you down. He probably has some other reason, though. 

Dr. Phelps

Published November, 2005