Risperidone Sodium valproate

Introduced in clinical practice in the 1960s, lithium was the first mood stabilizer to be used in China. This was followed by carbamazepine and sodium valproate. For many years, these were the only treatment options available as mood stabilizers. Although lamotrigine was approved for maintenance treatment of bipolar I disorder in 2003 by FDA (Food and Drug Administration) in the USA, this indication has not yet been approved by the Chinese authorities. At present, only one atypical antipsychotic drug, risperidone, has been approved for treating acute mania (February 2005 by SFDA [State Food and Drug Administration]) in China (see Table 6.1). 

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. 

A 26-year-old man who had taken risperidone 3 mg/ day and sodium valproate 1500 mg/day for 1 year developed a persistent erection, dysuria, and urinary incontinence, which did not respond to irrigation of the corpora cavernosa on two occasions and required surgical treatment (196). Prolonged priapism also resulted in penile fibrosis, associated with a high risk of permanent erectile dysfunction. 

Plasma concentrations of risperidone and 9-hydroxyris-peridone were measured in 44 patients (aged 26-63 years) taking risperidone alone (n = 23) or co-medicated with sodium valproate (n = 10) (154). Valproate had no major effect on plasma risperidone concentrations. 

Steady-state plasma concentrations of risperidone and 9-hydroxyrisperidone have been measured in 23 patients taking risperidone alone and in 10 co-medicated with sodium valproate (139). Valproate had no effect on the kinetics of risperidone. 

There are case reports describing oedema in patients taking risperidone and sodium valproate. Studies suggest that risperidone does not alter the pharmacokinetics of sodium valproate or valp-... 

Asterixis was attributed to clozapine in combination with sodium valproate and risperidone [115 ]. 

Another case of priapism in a 45-year-old male on risperidone and sodium valproate is reported [267 ]. Musculoskeletal A study of risperidone-associated prolactin elevation and markers of bone turnover found that prolactin levels significantly increased and N-telopeptide cross-links (markers of bone resorption) significantly decreased [268 ]. No differences were noted between men and women osteocalcin, N-telopeptide cross-links osteocalcin ratios, oes-tradiol and testosterone did not significantly change and there were no significant associations between risperidone dose and prolactin levels. 

---