Risperidone, a risk factor for valproate-induced encephalopathy?

Rodrigues-Silva, Nuno; Venâncio, Ângela; Bouça, J.

doi:10.1016/j.genhosppsych.2012.11.009

Cited by 11 publications

(6 citation statements)

References 6 publications

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“…Cases of VHE developing with simultaneous use of VPA and drugs like topiramate, quetiapine, or risperidone have been reported (10)(11)(12). It is known that the concomitantly used drug competes with VPA and thus may cause an increase in the free drug level (11). It is conceivable that the development of encephalopathy in our patient was also related to an increase in the free drug level due to the concurrent use of quetiapine or risperidone, even though the blood level of VPA was normal.…”

Section: Letter To the Editormentioning

confidence: 63%

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Valproic acid-induced Hyperammonemic Encephalopathy

Hocaoglu¹,

Özsoy²,

Bulut³

et al. 2020

Dusunen Adam

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Section: Letter To the Editormentioning

confidence: 63%

Section: Letter To the Editormentioning

confidence: 99%

Valproic acid-induced Hyperammonemic Encephalopathy

Hocaoglu¹,

Özsoy²,

Bulut³

et al. 2020

Dusunen Adam

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“…In adults, there seems to be no relationship between VPA daily dose and VHE severity. Also, there was no correlation between the duration of VPA use and the onset of VHE [32]. The fact that the individual has been treated without any previous complications with VPA does not indicate that VHE will not occur in the next treatment.…”

Section: Discussionmentioning

confidence: 88%

Hyperammonemic encephalopathy without hepatic dysfunction due to treatment with valproate: four cases and a mini review

Dinçer

Akgün

Bodur

et al. 2018

Psychiatry and Clinical Psychopharmacology

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Divalproex sodium/valproic acid (VPA) is an antiepileptic drug which is frequently prescribed in neurology and psychiatric clinics. Common side effects of VPA are side effects of the digestive system, weight gain, tremor, sedation, hematologic side effects and hair loss. Valproate-induced hyperammonemia is almost seen in 50% of patients treated with VPA, some of which may develop encephalopathy. Valproate-induced hyperammonemic encephalopathy (NE) is a well-known subject and there are numerous publications in the current literature. Although there is substantial evidence for this side effect in patients with neurological disorders, the data in the psychiatric area are limited. When we look at publications, it seems that VHE is seen more often because it starts earlier in psychiatric patients, but we think that it is often missed. Here, we presented five cases in which we followed up and treated with VHE diagnosis in our clinic within one year and other reports published previously in a table.

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“…It is also theorized that drugs such as risperidone affect VPA levels by competing for binding to albumin. With coadministration, risperidone binds to albumin, leaving increased levels of VPA, effectively leading to increased ammonia levels [5]. Because the mechanism is still unclear, it remains a challenge to identify the patients who would be at greater risk in developing this adverse reaction.…”

Section: Discussion/conclusionmentioning

confidence: 99%

Valproate-induced hyperammonemic encephalopathy: a case report

2020

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Background: Hyperammonemic encephalopathy is a rare and serious adverse reaction to valproate. Although there is documentation of this reaction in previous reports, very little is still known about the exact mechanism of action. In addition, there are no established guidelines of the next steps needed when a patient does develop this reaction. Therefore, this case report highlights what is known as well as the areas of research still needed. Case presentation: Our patient was a 57-year-old Caucasian woman with a medical history of bipolar I disorder, opioid use disorder, benzodiazepine use disorder, and Crohn's disease who was admitted to our behavioral health unit for suicidal ideation. She had been experiencing multiple panic attacks for 2.5 weeks along with poor sleep, increased energy, excessive spending, and feelings of helplessness. The patient was diagnosed with bipolar I disorder, manic episode without psychotic features, and benzodiazepine use disorder. She was started on valproic acid, citalopram, propranolol, and quetiapine. By day 6 of her hospitalization, the patient had altered mental status, varying levels of consciousness, confusion, and ataxic gait. Her ammonia levels were found to be elevated. All of her medications were discontinued, and lactulose was initiated. She returned to her baseline mentation within 48 hours and was discharged with lithium and quetiapine. The treatment team concluded that this patient had valproate-induced hyperammonemic encephalopathy, a rare but reversible reaction to valproate. Conclusion: Fortunately, rapid identification of this rare condition led to a favorable outcome in our patient. This case report illustrates the course of treatment in a patient who experienced this reaction and reviews current knowledge as well as areas of needed research in regard to valproate-induced hyperammonemic encephalopathy.

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Risperidone, a risk factor for valproate-induced encephalopathy?

Cited by 11 publications

References 6 publications

Valproic acid-induced Hyperammonemic Encephalopathy

Valproic acid-induced Hyperammonemic Encephalopathy

Hyperammonemic encephalopathy without hepatic dysfunction due to treatment with valproate: four cases and a mini review

Valproate-induced hyperammonemic encephalopathy: a case report

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