Nifedipine Valproate

Alternate treatments. Mood-stabilization and control of manic or hy-pomanic episodes in some subtypes of bipolar illness may also be achieved with the anticonvulsants valproate and carbamazepine, as well as with calcium channel blockers (e.g., verapamil, nifedipine, nimodipine). Effects are delayed and apparently unrelated to the mechanisms responsible for anticonvulsant and cardiovascular actions, respectively. 

Phenobarbital Enhances phasic GABAa receptor responses reduces excitatory synaptic responses Nearly complete absorption not significantly bound to plasma proteins peak concentrations in Vi to 4 h no active metabolites tjy2 varies from 75 to 125 h Generalized tonic-clonic seizures, partial seizures, myoclonic seizures, generalized seizures, neonatal seizures, status epilepticus Toxicity Sedation, cognitive issues, ataxia, hyperactivity Interactions Valproate, carbamazepine, felbamate, phenytoin, cyclosporine, felodipine, lamotrigine, nifedipine, nimodipine, steroids, theophylline, verapamil, others... 

Hiccup (due to diaphragmatic spasm). Where this is intractable and exhausting, chlorpromazine (or other phenothiazine) or metoclopramide may help also baclofen, nifedipine or sodium valproate. 

Nimodipine and possibly nifedipine levels are raised by valproate. 

One of the UK manufacturers of nifedipine notes that there is a theoretical possibility that levels of nifedipine may be increased in the presence of valproate. The US manufacturer recommends blood pressure monitoring during concurrent use and also suggests that a reduction in the dose of nifedipine should be considered. ... 

An 85-year-old woman with a schizoaffective disorder was given valproate 600 mg/day and after 4 days complained of muscle pain and weakness. Other medications were quetiapine 200 mg/day, nifedipine 10 mg/day, torsemide 10 mg/day, levothyroxine 75 micrograms/day, and acetylsalicylic acid 100 mg/day. There was a fivefold increase in myoglobin concentration (292 ig/l), a sixfold increase in creatine kinase activity (14 pmol/l), and slightly increased liver enzyme activities. The serum... 

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