Risperidone Divalproex

Agitation (chronic) Sodium divalproex Risperidone Olanzapine SSRI Trazodone Ziprasidone Haloperidol... 

Lithium, divalproex sodium (valproate), aripiprazole, olanzapine, que-tiapine, risperidone, and ziprasidone are currently approved by the FDA for treatment of acute mania in bipolar disorder. Lithium, olanzapine, and lamotrigine are approved for maintenance treatment of bipolar disorder. Quetiapine is the only antipsychotic that is FDA approved for bipolar depression. 

Mood stabilizers (e.g., lithium, valproic acid, and carbamazepine) used as augmentation agents may improve labile affect and agitated behavior. A placebo-controlled trial supports fast symptom improvement when divalproex is combined with either olanzapine or risperidone. 

In the Expert Consensus survey (Rush and Frances, 2000), respondents were asked to rate which classes of medication may be helpful for treating patients with severe and persistent physical aggression and those who destroyed property. The atypical antipsychotics were rated most highly, followed by anticonvulsant/ mood stabilizer. These were followed (with much lower priority) by antidepressants and beta-blockers. Among the atypical antipsychotics, risperidone was rated most highly, followed by olanzapine others had much lower ratings. Divalproex or valproic acid and carbamazepine were rated highest of the mood stabi-... 

A 30-year-old man developed neuroleptic malignant syndrome after taking risperidone and lithium carbonate for 1 week, having previously been taking olanzapine and divalproex (637). 

Pavuluri MN, Henry DB, Carbray JA, Sampson G, Naylor MW, Janicak PG. Open-label prospective trial of risperidone in combination with lithium or divalproex sodium in pediatric mania. J Affect Dis 2004 82S S103-11. 

Ravindran A, Silverstone P, Lacroix D, von Schaick E, Vermeulen A Alexander J. Risperidone does not affect steady-state pharmacokinetics of divalproex sodium in patients with bipolar disorder, Clin Phamacokimt (2004) 43, 733-40,... 

Baldassano CF, Ghaemi SN. Generalized edema with risperidone divalproex sodium treatment. J Clin Psychiatry (1996) 57, 422. 

Pavuluri MN, Henry DB, Findling RL, Parnes S, Carbray JA, Mohammed T, lanicak PG, Sweeney JA. Double-blind randomized trial of risperidone versus divalproex in pediatric bipolar disorder. Bipolar Disord 2010 12 593-605. 

Comparative studies Risperidone and divalproex In a retrospective study of 28 patients aged 5-14 years with bipolar disorder who had been treated with risperidone (n = 16) or divalproex (n = 12), risperidone was associated with faster clinical improvement and significantly more weight gain than divalproex (mean changes 2.46 kg versus 0.43 kg) however, the small sample size precluded definitive conclusions [120 . ... 

MacMillan CM, Withney JE, Kornddrfer SR, Tilley CA, Mrakotsky C, Gonzalez-Heydrich JM. Comparative clinical responses to risperidone and divalproex in patients with pediatric bipolar disorder. J Psychiatr Pract 2008 14(3) 160-9. 

Controlled Studies A controlled, randomised study compared oral risperidone, sodium divalproex in children and adolescents with bipolar I mania or mixed phase [23/d. Increased weight and BMI were significantly greater with risperidone treatment than with lithium or sodium divalproex treatment. There was a significant increase in LDL-cholesterol and decrease in HDL-cholesterol for the risperidone and sodium divalproex groups QTc prolongation (>440 ms) was reported in 9.0% of risperidone (also greatest increases), 10.0% of lithium and 3.0% of sodium divalproex-treated patients. 

Geller B, Luby JL, Joshi P, Wagner KD, Emslie G, Walkup JT, et al. A randomized controlled trial of risperidone, lithium, or divalproex sodium for initial treatment of bipolar 1 disorder, manic or mixed phase, in children and adolescents. Arch Gen Psychiatry 2012 69(5) 515-28. 

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