Hematological Effects of Valproate in Psychiatric Patients

Vasudev, Kamini; Keown, Patrick; Gibb, I; McAllister-Williams, R. Hamish

doi:10.1097/jcp.0b013e3181db2684

Cited by 55 publications

(41 citation statements)

References 24 publications

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“…It has further proven to be beneficial in multiple neurological pathologies, in the management of addictions to psychoactive drugs, in psychiatric diseases, cancer, and asthma, inter alia. [2][3][4] Its mechanism of action consists in potentiating the inhibitory activity of the gammaaminobutyric acid, attenuating the N-methyl d-aspartate mediated excitation and blocking the voltage dependent sodium, calcium and potassium channels. 1 Therapeutic levels are achieved within a 50-100-mcg/ml range.…”

Section: Discussionmentioning

confidence: 99%

Valproic acid and the risk of perioperative bleeding. Case report and literature review

Fajardo

Olmos

Sarmiento

2013

Colombian Journal of Anesthesiology

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a b s t r a c tValproic acid is one of the most widely used drugs for the treatment of epilepsy in children and adults since early 1967 to the present, and it is also useful for the treatment of refractory epilepsy and multiple conditions. 1 However, the use of this drug has been associated with blood disorders, including bone marrow suppression, alteration of the coagulation cascade and reduction of factor VIII and Von Willebrand factor, in addition to changes in the platelet numbers and function. In terms of the major surgery patient, all of these issues result in an increased risk of perioperative bleeding and a higher requirement of perioperative blood transfusion. A topic for discussion should then be whether the presence of these disorders is relevant for the morbidity and mortality of the patients and whether there is any clinical evidence of benefits for the patient when the drug is interrupted prior to surgery. Many hospital centers recommend stopping the use of valproic acid one to two weeks prior to surgery, though this recommendation is based on controversial evidence. It is our intent to submit a report of an abnormal uterine hemorrhage in the immediate postoperative period of curettage due to incomplete abortion with a history of chronic intake of valproic acid. Ácido Valproico y riesgo de sangrado perioperatorio. Reporte de caso y revisión de la literaturaPalabras clave: Ácido valproicoHemorragia Coagulación sanguínea Epilepsia r e s u m e n El ácido valproico es uno de los medicamentos más usados para el tratamiento de la epilepsia en niños y adultos desde inicios de 1967 hasta la actualidad, y es útil también para el tratamiento de epilepsia refractaria y múltiples enfermedades. 1 Sin embargo, el uso de este medicamento se ha asociado con alteraciones hematológicas que incluyen supresión medular, alteración de la cascada de la coagulación, disminución del factor VIII y factor de Von Willebrand, y alteración del número y función de las plaquetas, que en el ଝ Please cite this article as: Fajardo A, et al. Ácido Valproico y riesgo de sangrado perioperatorio. Reporte de caso y revisión de la literatura. Rev Colomb Anestesiol. 2013;41:61-4.

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Section: Discussionmentioning

confidence: 99%

Valproic acid and the risk of perioperative bleeding. Case report and literature review

Fajardo

Olmos

Sarmiento

2013

Colombian Journal of Anesthesiology

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“…This may be particularly important in older patients, for whom VPA dose reduction may be warranted [107].…”

Section: Hematologicalmentioning

confidence: 99%

Management of Adverse Effects of Mood Stabilizers

Murru

Popović

Pacchiarotti

et al. 2015

Curr Psychiatry Rep

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Mood stabilizers such as lithium and anticonvulsants are still standard-of-care for the acute and long-term treatment of bipolar disorder (BD). This systematic review aimed to assess the prevalence of their adverse effects (AEs) and to provide recommendations on their clinical management. We performed a systematic research for studies reporting the prevalence of AEs with lithium, valproate, lamotrigine, and carbamazepine/oxcarbazepine. Management recommendations were then developed. Mood stabilizers have different tolerability profiles and are eventually associated to cognitive, dermatological, endocrine, gastrointestinal, immunological, metabolic, nephrogenic, neurologic, sexual, and teratogenic AEs. Most of those can be transient or dose-related and can be managed by optimizing drug doses to the lowest effective dose. Some rare AEs can be serious and potentially lethal, and require abrupt discontinuation of medication. Integrated medical attention is warranted for complex somatic AEs. Functional remediation and psychoeducation may help to promote awareness on BD and better medication management.

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“…[13] Close monitoring of full blood count is required in female patients particularly at valproate serum level above 80 mcg/ml, especially in older patients. [14]…”

Section: Review Of Studies and Reports Of Vpa Related Coagulopathymentioning

confidence: 99%

Considerations in perioperative assessment of valproic acid coagulopathy

Abdallah

2014

J Anaesthesiol Clin Pharmacol

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Valproic acid (VPA) is one of the widely prescribed antiepileptic drugs in children with multiple indications. VPA-induced coagulopathy may occur and constitute a pharmacological and practical challenge affecting pre-operative evaluation and management of patients receiving VPA therapy. This review summarizes the different studies documenting the incidence, severity and available recommendations related to this adverse effect.

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Hematological Effects of Valproate in Psychiatric Patients

Abstract: In psychiatric patients on valproate therapy, close monitoring of full blood count is required in women particularly at valproate serum level above 80 microg/mL. This may be particularly important in older patients.

Cited by 55 publications

References 24 publications

Valproic acid and the risk of perioperative bleeding. Case report and literature review

Valproic acid and the risk of perioperative bleeding. Case report and literature review

Management of Adverse Effects of Mood Stabilizers

Considerations in perioperative assessment of valproic acid coagulopathy

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