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Adding valproic acid to lithium.
General information- Lithium is eliminated by the kidney for about 95%. Changes in the rate of excretion can cause unwanted effects.
- 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.
- Lithium and valproic acid are the most commonly used mood-stabilizing agents.[4]
- The combination of lithium and valproate appears to be well tolerated and effective in treating bipolar illness.[4]
- Addition of valproate to lithium has been recognized as a first-line treatment for mania that is refractory to lithium monotherapy.[4]
- The addition of valproate is most effective for patients with rapid cycling or mixed episodes.[4]
- This combination may be synergistic.[4]
- Lithium’s pharmacokinetics are not changed by valproate.[4]
- There may be additive adverse reactions due to this combination, such as weight gain, sedation, gastrointestinal complaints, and tremor.[4]
Start valproic acid- Start valproic acid according to the general dosing advice.
- ↑ 1.0 1.1 Farmacotherapeutisch Kompas - lithium (dutch)
Cite error: Invalid
<ref>tag; name "ftk" defined multiple times with different content - ↑ Farmacotherapeutisch Kompas; Toxicologie (dutch)
- ↑ KNMP; Informatorium Medicamentorum 2023; Monografie "valproaat" (Dutch)
- ↑ 4.0 4.1 4.2 4.3 4.4 4.5 4.6 Freeman et al. Mood stabilizer Combinations: A Review of Safety and Efficacy. Am J Psychiatry 1998;155:12-21
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