Valproate treatment

Acute head injuries A study evaluating the effect of IV valproate in the prevention of posttraumatic seizures in patients with acute head injuries found a higher incidence of death in valproate treatment groups compared with the IV phenytoin treatment group. Until further information is available, it seems prudent not to use valproate sodium injection in patients with acute head trauma for the prophylaxis of posttraumatic seizures. 

L. (1999) Valproate treatment and platelet function the role of arachidonate metabolites. Epilepsia 40 307-310. 

West, S.A., Keck P.E., Jr., and McElroy, S.L. (1995) Oral loading doses in the valproate treatment of adolecents with mixed bipolar disorder. / Child Adolesc Psychopharmacol 5 225-231. 

Bowden et al. [1994b] observed that a history of lithium nonresponse predicted lithium nonresponse, but not valproate nonresponse. Taken together, these studies suggest that a history of lithium nonresponse does not predict valproate nonresponse. Notably, no studies have examined whether a history of valproate treatment failure predicts future valproate or lithium response. 

Shukla GS Combined lithium and valproate treatment and subsequent withdrawal serotonergic mechanism of their interaction in discrete brain regions. Prog Neuropsychopharmacol Biol Psychiatry 9 153-156, 1985... 

Transient, mild increases in liver enzyme levels, up to three times the upper limit of normal, do not necessitate discontinuation of valproate. Although y-glutamyltransferase levels are often checked by clinicians, these levels are often increased, without clinical significance, in patients receiving valproate and carbamazepine (Dean and Penry 1992). Likewise, plasma ammonia levels are often increased transiently during valproate treatment, but this finding does not necessitate interruption of treatment (Jaeken et al. 1980). Increases in transaminase levels are often dose dependent. If no... 

Weight gain is a common side effect of valproate treatment. Isojarvi et al. (1996) reported significant weight gain with associated hyper-insulinemia in approximately 50% of a cohort of women taking valproate. This side effect does not appear to be dose dependent. Diet and exercise should be recommended early in treatment. 

Chronic valproate treatment did not change serum concentrations of lipids, vitamin B12, or folic acid in 26 children with epilepsy (1160). 

Following remission of manic symptoms in 37 patients who had taken perphenazine and a mood stabilizer (lithium, carbamazepine, or valproate), treatment was randomly assigned double-blind to perphenazine or placebo for 6 months, while continuing the mood stabilizer (1). Those who took perphenazine had worse outcomes than those who took placebo, in that they were more likely to have a shorter time to a depressive relapse, were more likely to discontinue treatment, or were more likely to have depression or extrapyramidal symptoms. The authors tentatively concluded that perphenazine may not be beneficial in maintenance treatment for bipolar I patients. 

Sanders RD, Lehrer DS. Edema associated with addition of risperidone to valproate treatment. J Clin Psychiatry 1998 59(12) 689-90. 

Elimination half-life in patients receiving concomitant valproate treatment approximately 59 hours after a single dose of lamotrigine... 

Although the association between polycystic ovary syndrome and valproate treatment appears to be established, current published studies are limited, owing to small sample sizes and diverse definitions of polycystic ovary syndrome. Thus, the true clinical relevance and frequency of the association needs further investigation in large, multicenter, prospective studies. 

In vitro tests have shown that valproate can increase the viral burden in HIV-infected individuals by potentiating replication of the virus (110). In a retrospective review of 11 HIV-positive patients with behavioral disturbances taking valproate HIV-1 viral load did not increase in six of the nine patients who had measurements between the first week and 3.5 months after the start of valproate treatment no follow-up was available for the other three (111). These data suggest that, contrary to in vitro data, HIV-1 viral load is not adversely affected by valproate in the presence of effective antiretroviral therapy. 

La Fiore LA, Jorge CL, Yacubian EMT. Reversible pseudoatrophy of the brain caused by valproate treatment How reversible is it Epilepsia 1999 40(Suppl. 2) 129-30. 

Syrjanen SM, Syrjanen KJ. Hyperplastic gingivitis in a child receiving sodium valproate treatment. Proc Finn Dent Soc 1979 75(5-6) 95-8. 

Other reports state that falls, no changes - " and even a slight rise in carbamazepine levels have been seen in some patients also taking sodium valproate or valproic acid. The serum levels of carbamazepine-10,11-epoxide are reported to be increased by about 50 to 100%. "" This active metabolite may cause the development of marked adverse effects such as blurred vision, dizziness, vomiting, tiredness and even nystagmus. " Acute psychosis, tentatively attributed to elevated epoxide levels, occurred in one patient when carbamazepine was added to sodium valproate treatment. ... 

An epileptic patient taking sodium valproate for 10 years had a 40% fall in his normally stable plasma levels from 67 to 40.5 mierograms/mL when acarbose was added. No other drugs were being taken. When the acarbose was stopped and then restarted, the valproate levels rose and then fell once again. The reason is not understood but the authors of the report suggest that the acarbose possibly reduces the absorption of valproate. This is an isolated report and its general importance is unknown, but it would seem prudent to be alert for any evidence of reduced effects if acarbose is added to valproate treatment. 

Ren M, Chuang DM. Combined lithium and valproate treatment delays disease... 

Encephalopathy has been studied in 63 adults who had taken valproate for a minimum of at least 2 years in a retrospective analysis [355 ]. Long duration of valproate treatment did not correlate with the risk of encephalopathy. In seven cases, temporary administration of lactulose alone was effective and valproate was not withdrawn. The authors also concluded that this complication is relatively common. 

Sabers A, Larsen K, Blichfeldt S, Sahlholdt L, Rasmussen JO. Valproate treatment during pregnancy description of four cases with foetal valproate... 

Gorjipour F, Asadi Y, Osguei NK, Efiatkhah M, Samadikuchaksaraei A. Serum level of homocysteine, folate and vitamin-B12 in epileptic patients under carbamazepine and sodium valproate treatment a systematic review and meta-analysis. Iran Red Crescent Med J March 2013 15(3) 249-53. 

---