* Valproic Lithium and valproic acid is principally metabolized by CYP2C9, CYP2C19, CYP2A6 and UDPare the most commonly used mood-glucuronosyltransferasesstabilizing agents. Valproic acid is an inhibitor <ref name="freeman">{{Pubmed|9433333|Freeman et al. Mood stabilizer Combinations: A Review of the enzymes CYP2C9, epoxideSafety and Efficacy. Am J Psychiatry 1998;155:12-hydroxylase 21}}</ref> * The combination of lithium and UDPvalproate appears to be well tolerated and effective in treating bipolar illness.<ref name="freeman"/>* Addition of valproate to lithium has been recognized as a first-glucuronosyltransferasesline treatment for mania that is refractory to lithium monotherapy. <ref name="freeman"/> * The addition of valproate is most effective for patients with rapid cycling or mixed episodes.<ref name="freeman"/> * This combination of drugs may have possible be synergistic effects. However, this combination will also have additive side effects<ref name="freeman"/>* Lithium’s pharmacokinetics are not changed by valproate. Dose adaptation will <ref name="freeman"/>* There may be recommended for additive adverse reactions due to this combination, such as weight gain, sedation, gastrointestinal complaints, and tremor.<ref name="freeman"/>