2018
DOI: 10.1016/j.rmcr.2018.05.026
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Hypoxic respiratory failure due to hyperammonemic encephalopathy induced by concurrent use of valproic acid and topiramate, a case report and review of the literature

Abstract: Valproic acid (VPA) is widely used for the treatment of epilepsy, migraine, and a variety of psychiatric symptoms, including bipolar disorder, borderline personality disorder, and alcohol withdrawal. Valproate is associated with severe idiosyncratic adverse effects, the most notable being valproate-induced hyperammonemic encephalopathy (VHE). Topiramate is also a broad-spectrum anticonvulsant that is also extensively used for migraine prophylaxis, as a mood stabilizer, and for alcohol dependency. There is incr… Show more

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Cited by 3 publications
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“…Hyperammonaemia has also been reported with topiramate, mostly when taken in combination with valproate, and rarely this can lead to encephalopathy. 8 9 Topiramate is a carbonic anhydrase inhibitor, directly limiting bicarbonate synthesis, which reduces the activity of the urea cycle enzyme carbonyl-phosphate synthetase-1, thus potentially causing hyperammonaemia. In patients taking topiramate (either alone or in combination with valproate), we would again suggest measuring ammonia only if there are symptoms suggesting hyperammonaemia.…”
Section: Specific Treatment Of Acute Severe Hyperammonaemiamentioning
confidence: 99%
“…Hyperammonaemia has also been reported with topiramate, mostly when taken in combination with valproate, and rarely this can lead to encephalopathy. 8 9 Topiramate is a carbonic anhydrase inhibitor, directly limiting bicarbonate synthesis, which reduces the activity of the urea cycle enzyme carbonyl-phosphate synthetase-1, thus potentially causing hyperammonaemia. In patients taking topiramate (either alone or in combination with valproate), we would again suggest measuring ammonia only if there are symptoms suggesting hyperammonaemia.…”
Section: Specific Treatment Of Acute Severe Hyperammonaemiamentioning
confidence: 99%