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. 2015 Apr 27;2015:542862. doi: 10.1155/2015/542862

Table 4.

VPA C/D ratio in Case 3.

Day1 VPA Phenytoin
Formulation Dose1 (mg/day) Concentration (μg/mL) C/D ratio C/D ratio × 1000 Dose (mg/day) Concentration (μg/mL)
All 137 VPA concentrations (C/D ratio × 1000: mean ± SD = 8 ± 3.5, range = 3–20)
70 therapeutic2 VPA concentrations (C/D ratio × 1000: mean ± SD = 9 ± 3.4, range = 5–18)
13 ECDVNa 3375 46 0.014 14 500 15
333 ECDVNa 3375 59 0.017 17 500 18
623 ECDVNa 3375 43 0.013 13 500 16
863 Concentrate 3350 22 0.007 7 500  
1173 ECDVNa 3450 43 0.012 12 500 11
1473 ECDVNa 3375 38 0.011 11 500 10
1623 Concentrate 3450 9 0.003 3 500  
1743 Concentrate 3450 28 0.008 8 500 18
1773 Concentrate 3450 31 0.009 9 500 18
1893 ECDVNa 3375 36 0.011 11 500  
2023 ECDVNa 3750 40 0.011 11 500 10
2083 ECDVNa 4125 40 0.010 10 500 14
2123 ECDVNa 4500 68 0.015 15 500 15
2443 ECDVNa 4500 61 0.014 14 500 15
2743 ECDVNa 4500 67 0.015 15 500 15
3073 ECDVNa 4500 46 0.010 10 500 23
3103 ECDVNa 4500 50 0.011 11 0 23
3133 ECDVNa 4500 39 0.009 9 500 10
3163 ECDVNa 4500 81 0.018 18 500 11
3203 ECDVNa 4500 31 0.007 7 500 15
3243 ECDVNa 4500 46 0.010 10 500 16
3353 ECDVNa 5000 64 0.013 13 500 19
3503 ECDVNa 5000 75 0.015 15 500 24
3983 ECDVNa 5000 52 0.010 10 460 16
4003 ECDVNa 5000 85 0.017 17 460 11
4303 ECDVNa 5000 59 0.012 12 460 16
4393 ECDVNa 5000 65 0.013 13 460 18
4703 ECDVNa 5000 54 0.011 11 460 16
5023 ECDVNa 5000 53 0.011 11 460 20
5304 ECDVNa 5000 77 0.015 15 460 17
5594 ECDVNa 5000 50 0.010 10 460 13
5905 ECDVNa 5000 48 0.010 10 460 12
6216 ECDVNa 5000 37 0.007 7 460 10
6356 ECDVNa 5000 39 0.008 8 460 11
6466 ECDVNa 5250 35 0.007 7 460 13
6817 ECDVNa 5250 37 0.007 7 460 8
7137 ECDVNa 5250 46 0.009 9 460 7
7347 ECDVNa 5250 40 0.008 8 460 10
7627 ECDVNa 6000 53 0.009 9 460 9
7707 ECDVNa 6000 43 0.007 7 460 8
7987 ECDVNa 6000 23 0.004 4 460 9
8067 ECDVNa 6000 32 0.005 5 460 10
8177 ECDVNa 7500 36 0.005 5 200 9
8317 ECDVNa 7500 43 0.006 6 460 5
8387 ECDVNa 7500 47 0.006 6 460 15
8467 ECDVNa 7500 24 0.003 3 460 10
8527 ECDVNa 7500 35 0.005 5 460 8
8607 ECDVNa 7500 51 0.007 7 460
8667 ECDVNa 7500 42 0.006 6 460 3
8887 ECDVNa 7500 71 0.009 9 460 20
8907 ECDVNa 7500 81 0.011 11 460 20
9167 ECDVNa 7500 45 0.006 6 460 7
9197 ECDVNa 7500 46 0.006 6 460 7
9297 ECDVNa 8250 43 0.005 5 460  
9437 ECDVNa 9000 43 0.005 5 460  
9507 ECDVNa 9000 50 0.006 6 460  
9577 ECDVNa 9000 75 0.008 8 460  
9647 ECDVNa 9000 37 0.004 4 460  
9717 ECDVNa 9000 28 0.003 3 460  
9727 ECDVNa 9000 44 0.005 5 460 8
9797 ECDVNa 9000 64 0.007 7 460 6
9857 ECDVNa 9000 38 0.004 4 460 9
9897 ECDVNa 9000 50 0.006 6 460 8
9927 ECDVNa 9000 59 0.007 7 460 9
9997 ECDVNa 9000 54 0.006 6 460 6
10147 ECDVNa 9000 35 0.004 4 460 6
10207 ECDVNa 9000 42 0.005 5 460 5
10297 ECDVNa 10500 43 0.004 4 460 7
10357 ECDVNa 10500 102 0.010 10 460 6
10397 ECDVNa 10500 54 0.005 5 460 1
10427 ECDVNa 10500 77 0.007 7 460 6
10567 ECDVNa 10500 120 0.011 11 460 6
10627 ECDVNa 10500 39 0.004 4 460 8
10647 ECDVNa 10500 47 0.004 4 460 7
10707 ECDVNa 10500 56 0.005 5 460 6
10807 ECDVNa 10500 51 0.005 5 460 10
10917 ECDVNa 10500 54 0.005 5 460 11
10987 ECDVNa 10500 63 0.006 6 460 12
11057 ECDVNa 10500 49 0.005 5 460 12
11127 ECDVNa 10500 47 0.004 4 460 8
11197 ECDVNa 10500 51 0.005 5 460 6
11337 ECDVNa 10500 91 0.009 9 460 7
11487 ECDVNa 10500 50 0.005 5 460 13
11637 ECDVNa 10500 40 0.004 4 460 9
11687 ECDVNa 10500 62 0.006 6 460 10
11757 ECDVNa 10500 63 0.006 6 460 13
11827 ECDVNa 10500 110 0.010 10 460 11
11847 ECDVNa 10500 61 0.006 6 460 10
11897 ECDVNa 10500 56 0.005 5 460 10
11967 ECDVNa 14000 133 0.010 10 460 9
12107 ECDVNa 10500 67 0.006 6 460 13
12177 ECDVNa 10500 65 0.006 6 460 14
12247 ECDVNa 10500 87 0.008 8 460 11
12317 ECDVNa 10500 70 0.007 7 460 13
12457 ECDVNa 10500 65 0.006 6 460 15
12527 ECDVNa 10500 97 0.009 9 460 9
12597 ECDVNa 10500 77 0.007 7 460 13
12667 ECDVNa 10500 56 0.005 5 460 12
12737 ECDVNa 10500 97 0.009 9 460 14
12807 ECDVNa 10500 60 0.006 6 460 16
12878 ECDVNa 10500 39 0.004 4 460 19
12948 ECDVNa 10500 103 0.010 10 460 15
13018 ECDVNa 10500 48 0.005 5 460 19
13078 ECDVNa 10500 72 0.007 7 460 13
13168 ECDVNa 10500 54 0.005 5 460 13
13228 ECDVNa 10500 71 0.007 7 460 13
13298 ECDVNa 10500 75 0.007 7 460 13
13368 ECDVNa 10500 98 0.009 9 460 12
13448 ECDVNa 10500 93 0.009 9 460 11
13508 ECDVNa 10500 65 0.006 6 460 15
13578 ECDVNa 10500 58 0.006 6 460 23
13648 ECDVNa 10500 73 0.007 7 460 18
13718 ECDVNa 10500 106 0.010 10 460 24
13738 ECDVNa 10500 106 0.010 10 460 20
13788 ECDVNa 10500 89 0.008 8 460 15
13868 ECDVNa 10500 97 0.009 9 460 17
13928 ECDVNa 10500 72 0.007 7 460 21
13938 ECDVNa 10500 87 0.008 8 460 23
13948 ECDVNa 10500 122 0.012 12 230 22
13958 ECDVNa 3500 37 0.011 11 0 20
13998 ECDVNa 10500 130 0.012 12 400 8
14068 ECDVNa 10500 94 0.009 9 400 10
14138 ECDVNa 10500 126 0.012 12 400 12
14208 ECDVNa 10500 108 0.010 10 400 12
14278 ECDVNa 6000 59 0.010 10 400 21
14358 ECDVNa 9000 110 0.012 12 400 5
14408 ECDVNa 9000 86 0.010 10 400 8
14448 ECDVNa 9000 82 0.009 9 400 10
14488 ECDVNa 9000 147 0.016 16 400 10
14547 ECDVNa 7000 93 0.013 13 400 14
14579 ECDVNa 7000 138 0.020 20 400 11
146110 ECDVNa 7000 72 0.010 10 400 13
147011 ECDVNa 7000 101 0.014 14 400 13
1478 ECDVNa 7000 113 0.016 16 400 7
1483 ECDVNa 7000 97 0.014 14 400 6

C/D: concentration-to-dose; ECDVNa: enterocoated divalproex sodium; VPA: valproic acid.

1After day 1420, VPA dose was guided more by physical comfort than VPA concentrations; therefore, these latter days were eliminated to calculate the Pearson correlation between day of admission and VPA dose, which was r = 0.92 (p < 0.001); VPA dose remained very high in a partial correlation while controlling for VPA concentration: r = 0.89 (p < 0.001). This is compatible with a progressive autoinduction indicating, at least with dose range, that it was necessary to increase the dose as the duration lengthened. When all values (including those after day 1420) were used to calculate correlations, the r values were, not surprisingly, slightly reduced both for the total correlation of r = 0.83 (p < 0.001) and the partial correlation of r = 0.78 (p < 0.001).

250–100 μg/mL concentrations are considered therapeutic concentrations. As this patient has too many nontherapeutic concentrations, it may be better to compare with other patients using only the VPA therapeutic concentrations.

3Other scheduled oral medications included benztropine 4 mg/day, mesoridazine 200 mg/day, lorazepam 6 mg/day, and risperidone 12 mg/day.

4Other scheduled oral medications included benztropine 4 mg/day, lorazepam 6 mg/day, and risperidone 12 mg/day.

5Other scheduled oral medications included benztropine 4 mg/day, lorazepam 6 mg/day, and risperidone 4 mg/day.

6Other scheduled oral medications included benztropine 4 mg/day and lorazepam 6 mg/day.

7Other scheduled oral medications included lorazepam 6 mg/day.

8Other scheduled oral medications included lorazepam 6 mg/day and trazodone 150 mg/day.

9Other scheduled oral medications included lorazepam 4 mg/day.

10Other scheduled oral medications included lorazepam 3 mg/day.

11Other scheduled oral medications included lorazepam 1 mg/day.