Valproate haloperidol

SODIUM PHENYLBUTYRATE CORTICOSTEROIDS, HALOPERIDOL, VALPROATE Possibly i efficacy of sodium phenylbutyrate These drugs are associated with t ammonia levels Avoid co-administration... 

Caine ED, Polinsky RJ Haloperidol induced dysphoria in patients with Tourette syndrome. Am J Psychiatry 236 1216-1217, 1979 Caine ED, Weingartner H, Ludlow EA, et al Qualitative analysis of scopolamine-induced amnesia. Psychopharmacology 74 74-80, 1981 Calabrese JR, Delucchi GA Spectrum of efficacy of valproate in 55 rapid-cycling manic depressives. Am J Psychiatry 147 431-434, 1990 Calabrese JR, Markowitz PJ, Kimmel SE, et al Spectrum of efficacy of valproate in 78 rapid-cycling bipolar patients. J Clin Psychopharmacol 12 (suppl 53-56, 1992... 

Freeman TW, Clothier JL, Pazzaglia P, et al A double-blind comparison of valproate and lithium in the treatment of acute mania. Am J Psychiatry 149 108-111,1992 Frenchman IB, Prince T Clinical experience with risperidone, haloperidol, and thioridazine for dementia-associated behavioral disturbances. Int Psychogeriatr 9 431-435, 1997... 

Another use of the laboratory is for therapeutic drug monitoring (TDM) of psychotropics with defined optimal ranges, narrow therapeutic indices, or both. Although TDM is not essential for many psychotropics, it is for others, including lithium, several TCAs, valproate, and carbamazepine. It may also be helpful to optimize the use of certain antipsychotics (e.g., haloperidol, clozapine) ( 7). 

Limited evidence indicates that carbamazepine plus an antipsychotic may also benefit some schizophrenic patients. This is an interesting possibility in view of the similar antimanic properties of lithium and carbamazepine (375). This area requires further research, especially to clarify the indications for combining anticonvulsants with an antipsychotic. For example, mania complicated by psychotic features may benefit from lithium, valproate, or carbamazepine augmented by antipsychotics. Because carbamazepine induces the metabolism of at least some antipsychotics (e.g., haloperidol, thiothixene), dose adjustment based on TDM may be necessary to achieve the optimal effect. 

Carbamazepine is a hepatic microsomal enzyme inducer and therefore will lower the serum concentration of a wide variety of drugs given concurrently. These include the antiepileptic drugs phenytoin, primidone, valproate, ethosuximide and clonazepam. In addition, carbamazepine can compromise the therapeutic effects of oral contraceptives, oral anticoagulants, beta-blockers, haloperidol and theophylline. 

A 62-year-old woman became delirious when lithium at therapeutic concentrations was added to valproate, haloperidol, and biperiden (232). The delirium resolved after all drugs were withdrawn, but 6 months later she still had choreoathetoid movements. 

An interaction between valproate and haloperidol has been reported (61). 

A 30-year-old man with bipolar affective disorder was given intravenous sodium valproate 20 mg/kg/day without any major problem. Later, he was given oral haloperidol 10 mg bd for persistent aggressive behavior and manic symptoms. The next day he developed a sense of imbalance and started swaying. He was drowsy and had cerebellar ataxia. Haloperidol was withdrawn and within 1 day his ataxia had disappeared completely in spite of continuing valproate. 

Ranjan S, Jagadheesan K, Nizamie SH. Cerebellar ataxia with intravenous valproate and haloperidol. Aust NZ J Psychiatry 2002 36(2) 268. 

After first trimester carbamazepine, lamotrigine, oxcarbazepine, or valproate Second choice benzodiazepine (lorazepam) Third choice calcium channel blocker With psychosis first choice adjunctive high-potency typical antipsychotic (haloperidol, perphenazine, thiothixene, or trifluoperazine)... 

Phenytoin and carbamazepine have been reported to decrease haloperidol serum levels by about 50% due to their hepatic cytochrome P450-inducing properties. Preliminary data suggest that haloperidol can lower valproate serum levels. 

Haloperidol plasma levels are roughly halved by carbamazepine, phenobarbital and phenytoin. Bromperidol, fluphenazine and ti-otixene levels are also reduced by carbamazepine. The plasma levels of chlorpromazine and haloperidol do not appear to be affected by oxcarbazepine. Neurotoxicity has been seen with haloperidol and carbamazepine and haloperidol can raise serum carbamazepine levels. Valproate or valproic acid appear not to interact. 

A study in 6 patients given haloperidol 6 to 10 mg daily found no significant interaction with valproic acid. Similarly, haloperidol was not found to interact with valproate in two further studies, although in one of these studies an increase of 64% in haloperidol plasma levels was seen, which was considered not significant. For the interaction of valproic acid with chlorpromazine, see Valproate + Chlorpromazine , p.577. 

Hesslinger B, Normann C, Langosch JM, Klose P, Berger M, Walden J. Effects of carbamazepine and valproate on haloperidol plasma levels and on psychopathologic outcome in schizophrenic patients. J Clin Psychopharmacol (1999) 19,310-15. 

Sekhar S, Kaha B, Mendhekar DN, Tekur U. Efficacy of sodium valproate and haloperidol in the management of acute mania a randomized open-label comparative study. J Chn Pharmacol 2010 50(6) 688-92. 

Carbamazepine levels are increased by CYP3A4 inhibitors (cimetidine, macrolides, diltiazem, fluoxetine, ketoconazole, verapamil, valproate) levels are decreased by CYP3A4 inducers (cisplatin, doxorubicin, felbamate, phenobarbital, phenytoin, primidone, rifampin, theophylline). Carbamazepine may increase levels of clomipramine, phenytoin, and primidone and lithium toxicity may decrease levels of phenytoin, warfarin, oral contraceptives, doxycycline, theophylline, haloperidol, alprazolam, clozapine, ethosuximide, and valproate may interfere with other anticonvulsants. 

Test Psychosis patients Clozapine Haloperidol Quetiapine BPAD patients Lithium Valproate Carbar... 

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