Adding valproic acid to risperidone.
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- Risperidone is principally metabolized by CYP2D6 to an active metabolite 9-OH-risperidone (paliperidone).
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- Valproic acid is principally metabolized by CYP2C9, CYP2C19, CYP2A6 and UDP-glucuronosyltransferases. Valproic acid is an inhibitor of the enzymes CYP2C9, epoxide-hydroxylase and UDP-glucuronosyltransferases.
Start valproic acid
- Coadministration with risperidone may alter the serum concentrations of valproic acid, although data are conflicting.
- Start valproic acid according to the general dosing advice.
Stop valproic acid
- Dose-related generalised oedema is reported. 
- Antipsychotics lower the seizure threshold and may antagonise the anticonvulsant effect of valproate. 
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