Study on Optimal Dose of Sodium Valproate (VPA) in Treating Bipolar Mood Disorder (BMD) Patients in Hospital Melaka

Introduction: Sodium Valproate (VPA) has been commonly used as mood stabilizers worldwide in treating Bipolar Mood Disorder (BMD). Suboptimal dosing or poor clinical responses towards VPA often resulted in relapse episodes among BMD patients. Evaluation of aggressive initial dosing and serum level with efficacy and BMD relapses are crucial in maximizing clinical benefits while minimizing undesirable adverse events or incidence of relapses. This study aims to determine the optimal dose of VPA in management of BMD. Methodology: A cross-sectional study was conducted in Psychiatric Clinic Hospital Melaka from August 2017 till August 2019. Statistical analysis was done by using SPSS version 21. A value of p< 0.05 was considered statistically significant.
Results: Among 49 included patients, 20 patients had a history of relapse. The VPA doses among patients with history of relapse were statistically significantly higher (921.5 [371] mg and 600 [396] mg, p=0.003). However, the serum level between patients with and without history of relapse were not statistically significant (65.5 [57.8] mcg/ml and 46.53 [18.29] mcg/ml, p=0.668). Among patients with relapse, the VPA dose and serum level prior to admission were not significantly different compared to dose and level after admission. Only 12 patients experienced side effects while on VPA. The most common reported side effect is sedation. Discussion: Patients with history of relapse requiring hospitalization were on higher dose and achieved higher serum level of VPA than patients without a history of relapse although the latter was not statistically significant. The median serum level in non-relapse patient was lower than the recommended target range of 50-125 mcg/ml. In the subgroup of patients with history of relapse requiring admission, neither mean dose nor serum level of patients before and after admission was significantly different. Other studies have revealed a possible correlation between severity of disease and serum level of VPA required for disease stabilisation. Nevertheless, other contributing factors such as age, body weight and concomitant therapy need to be taken into consideration. As for safety profile, 12 patients on VPA reported at least one adverse effect, with the most common adverse effect being sedation and weight gain. None of the adverse effects resulted in withdrawal of therapy. Conclusion: Our study was unable to determine an optimal dose of VPA in the management of BMD. Future studies should include other contributing factors that may affect disease control. [Disclaimer: Abstract text might vary slightly from what is displayed in the e-poster]