Adding lithium to valproic acid.
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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.
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- Lithium is eliminated by the kidney for about 95%. Changes in the rate of excretion can cause unwanted effects.
- Lithium and valproic acid are the most commonly used mood-stabilizing agents.
- The combination of lithium and valproate appears to be well tolerated and effective in treating bipolar illness.
- Addition of lithium to valproic acid is the treatment of choice for acute mania with partial but inadequate response to valproate.
- This combination may be synergistic.
- Lithium’s pharmacokinetics are not changed by valproate.
- There may be additive adverse reactions due to this combination, such as weight gain, sedation, gastrointestinal complaints, and tremor.
- Start lithium acid according to the general dosing advice.
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