Depakote ER QD

[PENVK]

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Got a transfer yesterday and the other pharmacy didn't check but the SIG was BID? What's the point of using the QD formulation if prescribed as BID. Checking with MD to see if it was an error. What y'all think?
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[rph3664]

The patient most likely has GI side effects when they take the dose all at once that they don't when they use it BID. I've seen it dosed this way too.

 

[PENVK]

The patient most likely has GI side effects when they take the dose all at once that they don't when they use it BID. I've seen it dosed this way too.

Let me clarify that this is the 'Depakote ER QD'. It's the blue and white bottle that states 'Depakote ER QD' on the label. I think it was a mis-filled. They couldn't find the original prescription to confirm. If it was dosed BID then might as well use depakote EC.

 

[owlegrad]

Not sure I have seen it with depakote but how many times do you see this with metoprolol or cadizem? All the time. So stupid.

 

[farmadiazepine]

They do depakote ER bid all the time in psych. The reasoning is that it provides smoother drug levels. Thats what I learned from Cornell psych rotation

 

[Praziquantel86]

Not sure I have seen it with depakote but how many times do you see this with metoprolol or cadizem? All the time. So stupid.

Why is metoprolol XL stupid if its given more than once daily?

 

[xiphoid2010]

Off label use and dosing happens all the time. If you keep trying to chase down every little one, you will just be driving yourself and MD crazy. Use clinical judgment. First do no harm. Is dosing toprol xl 50mg bid harmful? How about levaquin 750 mg bid? Before you call, think it through the possibilities. Physician trust of pharmacy competency is much more easily lost than it is to build.

 

[owlegrad]

Why is metoprolol XL stupid if its given more than once daily?

Why not use tartrate if you want BID dosing?

 

[npage148]

Why not use tartrate if you want BID dosing?

Pk

 

[owlegrad]

Pk

What's the advantage though?

 

[npage148]

What's the advantage though?

You're the student, you tell me

 

[jrlbc06]

Succinate peak levels are about 1/3 those of tartrate, giving a more steady level over the dosing interval.

Based on that, I would imagine that tartrate will have a higher incidence of hypotensive adverse events, at least during the peak concentration periods. Succinate will give a more level/constant effect with patients less likely to have large swings in BP.

 

[owlegrad]

You're the student, you tell me

I don't know any advantage of using succinate BID.

 

[Farmercyst]

I don't know any advantage of using succinate BID.

Which is better 50 mg succinate BID, 100mg QD, or 100mg tartrate BID?

 

[thephoenician88]

Which is better 50 mg succinate BID, 100mg QD, or 100mg tartrate BID?

"In comparison to conventional metoprolol, the plasma metoprolol levels following administration of metoprolol succinate extended-release are characterized by lower peaks, longer time to peak and significantly lower peak to trough variation. The peak plasma levels following once-daily administration of metoprolol succinate extended-release average one-fourth to one-half the peak plasma levels obtained following a corresponding dose of conventional metoprolol, administered once daily or in divided doses. At steady state the average bioavailability of metoprolol following administration of metoprolol succinate extended-release, across the dosage range of 50 to 400 mg once daily, was 77% relative to the corresponding single or divided doses of conventional metoprolol. Nevertheless, over the 24-hour dosing interval, β1-blockade is comparable and dose-related [see Clinical Pharmacology (12)]. The bioavailability of metoprolol shows a dose-related, although not directly proportional, increase with dose and is not significantly affected by food following metoprolol succinate extended-release administration."

Defn not C, I would choose B. If they're BP/ pulse is still high, i would increase the succinate dose but keep it once a day. Attempting to minimize # of tablets a pt takes.

 

[Carboxide]

Which is better 50 mg succinate BID, 100mg QD, or 100mg tartrate BID?

http://journals.lww.com/cardiovascu...kinetic_Considerations_of_Formulation_.1.aspx

This study indicates that there are no real peaks/troughs with succinate QD. Therefore, definitely 100 mg QD...since it decreases pill burden and will improve compliance.

 

[thephoenician88]

http://journals.lww.com/cardiovascu...kinetic_Considerations_of_Formulation_.1.aspx

This study indicates that there are no real peaks/troughs with succinate QD. Therefore, definitely 100 mg QD...since it decreases pill burden and will improve compliance.

beat you by 5 mins
boom

😛

 

[Carboxide]

beat you by 5 mins
boom

😛

Saw it...but you're pre-pharm...so I didn't trust you.

 

[nextyearrx]

I just saw a prescription of Tiazac (diltiazem) dosed BID. My preceptor pharmacist asked me if I knew it is OK. I said it should be QD b/c it is extended release.

It is so confusing when you see prescriptions for BID for ER formulations, but Rare cases DO Exists..🙂

 

[Praziquantel86]

http://journals.lww.com/cardiovascu...kinetic_Considerations_of_Formulation_.1.aspx

This study indicates that there are no real peaks/troughs with succinate QD. Therefore, definitely 100 mg QD...since it decreases pill burden and will improve compliance.

I'd look at the graphs in that study again.