Study on Optimal Dose of Sodium Valproate (VPA) in Treating Bipolar Mood Disorder (BMD) Patients in Hospital Melaka Chong Lai Peng1,Siti Rahmah Johari1, Lim Kar Ying1, Tay Eek Poei1,Ng Siok Shen1, Koo Suk Kuan1 P-73 Institutional logo (optional) NMRR NO: NMRR-17-2035-36555 Discussion Methodology Conclusion Results Variable With Admission (N = 20) Median (IqR) Without Admission (N = 29) Median (IqR) Z stat * p value* VPA dose 921.5 (371) 600 (396) -2.93 0.003 Serum level 65.5 (57.8) 46.5 (18.3) -0.428 0.668 Variable Acute BMD (N = 20) Mean (SD) Remission (N = 20) Mean (SD) Mean of Dose difference (95% CI) T stat (df) p value* VPA dose 984.2 (318.5) 935.6 (318.6) -48.6 (-197.951, 100.751) -0.681 (19) 0.504 Serum level 67.6 (33.3) 59.9 (43.1) -7.67 (-33.31, 17.97) -0.707 (7) 0.502 Table 1: Comparison VPA doses and serum level between patients with history of admission and without admission in Hospital Melaka Table 2: Comparison VPA doses and serum level during acute and remission phase among patients have been admitted in Hospital Melaka 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. 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. Patients with history of relapse requiring hospitalization were on higher dose and achieved higher serum level of VPA than patients without 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 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 most common adverse effect being sedation and weight gain. None of the adverse effect resulted in withdrawal of therapy. Our study was unable to determine an optimal dose of VPA in the management of BMD. Future study should include other contributing factors that may affect disease control. *Mann Whitney test *paired t-test Acknowledgement We would like to express our gratitude and appreciation to Director General of Health, Director of GHM, Chief Pharmacist of GHM, Psychiatric Clinic Hospital Melaka, and those who have directly and indirectly contributed to the success of this study. Introduction 1Hospital Melaka, Ministry of Health Figure 1: Flowchart describing study flow and data collection process for the analysis of VPA doses and serum level Figure 2: Adverse events among BMD patients treated with VPA Sedation Weight Gain Thrombocytopenia Oedema Others Tremor BMD pt on VPA n=68 Without admission* n = 41 With admission* n= 27 Recruited n=29 VPA dosing and serum level Recruited n=20 *Admission: hospitalization due to disease relapse #Excluded due to incomplete data Excluded# n=12 Excluded# n=7