Valproatereatment of Acute Mania

Pope, H. G.; Sl, McElroy; Pe, Keck; Ji, Hudson

doi:10.1001/archpsyc.1991.01810250064008

Cited by 406 publications

(59 citation statements)

References 18 publications

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“…We would like to point out additionally that, compared to previous research [6,7,9,16], the therapeutically significant level of serum SV of at least 50 mg/ml had already been achieved in the loading condition after the first day of treatment, whereas in the maintenance condition this level was only reached after 3 days of treatment. We also noted, however, that this latter was still more rapid than the time lag reported by Hirschfeld et al [7] for a nonloading condition, and as quick as observed in the loading condition reported by Oluboka et al [6].…”

Section: Discussionmentioning

confidence: 61%

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Oral Loading of Sodium Valproate Compared to Intravenous Loading and Oral Maintenance in Acutely Manic Bipolar Patients

Ghaleiha

Haghighi²,

Sharifmehr³

et al. 2014

Neuropsychobiology

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Background: In patients suffering from bipolar disorders (BPD), we explored to what extent oral loading of sodium valproate (SV) leads to more rapid symptom improvement compared to intravenous loading and oral maintenance administration. Methods: Ninety patients (mean age: 35.00 years) with BPD and currently in an acute manic state were randomly assigned to one of three study conditions: oral loading (20 mg/kg oral single-dose SV on the first day, then 10-15 mg/kg SV daily, divided dose), intravenous loading (20 mg/kg SV intravenous injection on the first day, then 10-15 mg/kg orally, divided dose), or oral maintenance administration (15-20 mg/kg SV daily from the beginning) over the first 7 days of treatment. SV plasma levels, side effects and symptoms were evaluated at baseline and on days 1, 3, and 7 after commencing treatment. Results: There were significant Time-by-Group interactions for symptom improvements, symptom severity, and SV plasma levels, with positive values in the oral and intravenous loading conditions, compared to the oral maintenance condition. Post hoc analyses showed that oral and intravenous conditions led to similar improvements. Conclusions: Both oral and intravenous loading of SV led to quicker and more efficient improvement and SV plasma levels as compared to an oral maintenance regimen.

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Section: Discussionmentioning

confidence: 61%

“…A trough serum level of SV above 50 mg/ml has been obtained 5-10 days after treatment began [9,16], but has also been apparent after the first 3 days of treatment with oral loading, as compared to the titration condition [6]. …”

Section: Introductionmentioning

confidence: 99%

Oral Loading of Sodium Valproate Compared to Intravenous Loading and Oral Maintenance in Acutely Manic Bipolar Patients

Ghaleiha

Haghighi²,

Sharifmehr³

et al. 2014

Neuropsychobiology

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“…Valproate is now FDA-approved for the treatment of acute mania based on several placebo-controlled clinical trials demonstrating efficacy (Pope et al 1991;Bowden et al 1994). However, in the study of Bowden et al, only 50% of the patients showed a 50% or greater response at the end of the 3-week study, findings in parallel with those of lithium.…”

Section: Valproatementioning

confidence: 99%

Beyond Lithium in the Treatment of Bipolar Illness

Post

1998

Neuropsychopharmacology

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“…However, the range recommended in the literature for acute mania is 45-125 mg/L in adult patients and 65-90 mg/L in older patients; in maintenance therapy, blood levels of 55-115 mg/L have been recommended. [12][13][14][15] For this report, we used the ranges advised by our national guidelines 16 : 60-80 mg/L in maintenance therapy and 80-120 mg/L in acute episodes.We present a case in which signs of valproate intoxication were clinically present, although the valproate trough concentrations were considered therapeutic (60-120 mg/L).Case report. Ms A, a 78-year-old woman, was admitted to a geriatric psychiatry ward because of psychosis with manic features.…”

mentioning

confidence: 99%

Valproate Intoxication in a Patient With Blood Valproate Levels Within Therapeutic Range

Smits¹,

Wallenburg²,

Spanje³

et al. 2017

J. Clin. Psychiatry

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V alproate (valproic acid), a well-established anticonvulsant, is principally effective in bipolar disorder. [1][2][3][4] In addition, valproate has been used for the management of a range of psychiatric conditions, such as schizophrenia, personality disorder, anxiety, and agitation in dementia. [4][5][6] The need for therapeutic drug monitoring of valproate in the treatment of epilepsy has been demonstrated. A plasma trough concentration exceeding 50 mg/L is advised in order to reach therapeutic effects on epilepsy, and trough levels exceeding 100-120 mg/L are associated with toxicity and occurrence of adverse events. [6][7][8][9][10][11] There is no clear concentration-response relationship for valproate in most psychiatric conditions. However, the range recommended in the literature for acute mania is 45-125 mg/L in adult patients and 65-90 mg/L in older patients; in maintenance therapy, blood levels of 55-115 mg/L have been recommended. [12][13][14][15] For this report, we used the ranges advised by our national guidelines 16 : 60-80 mg/L in maintenance therapy and 80-120 mg/L in acute episodes.We present a case in which signs of valproate intoxication were clinically present, although the valproate trough concentrations were considered therapeutic (60-120 mg/L).Case report. Ms A, a 78-year-old woman, was admitted to a geriatric psychiatry ward because of psychosis with manic features. The patient's psychiatric history revealed schizoaffective disorder (DSM-5 criteria), and her somatic history included a stroke, metabolic syndrome, and chronic renal insufficiency. Psychiatric examination showed high speed in thinking, delusions, command auditory hallucinations, and a euphoric mood. Physical examination showed no abnormalities besides obesity and hyperkinesia due to haloperidol. Laboratory tests showed chronic renal insufficiency (clearance of 59 mL/min/1.73 m 2 [reference > 90 mL/min/1.73 m 2 ]).Prescription of lithium carbonate was not the first choice due to lack of efficacy in the past and side effects (tremor and decline of renal function) in combination with the current reduced renal function. Ms A's manic psychosis was treated with valproate and haloperidol. Valproate was dosed according to the patient's body weight in a ratio of 20 mg/kg, which resulted in a daily dosage of 2,100 mg.Two weeks later, she developed a fluctuating mental status with complaints of sedation, vertigo, and insecurity in walking with falling. Physical examination revealed no new abnormalities, and laboratory tests showed a serum albumin level of 26 g/L (reference, 35-50 g/L) and a plasma trough concentration of 91.9 mg/L (reference, 60-120 mg/L). In medication review by the pharmacist, a free protein unbound trough concentration level of valproate was determined at 34.7 mg/L (reference, 4-12 mg/L). Adjusting the daily valproate dosage to 600 mg resulted in a total valproate level of 49.9 mg/L and a free concentration of 6

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Valproatereatment of Acute Mania

Cited by 406 publications

References 18 publications

Oral Loading of Sodium Valproate Compared to Intravenous Loading and Oral Maintenance in Acutely Manic Bipolar Patients

Oral Loading of Sodium Valproate Compared to Intravenous Loading and Oral Maintenance in Acutely Manic Bipolar Patients

Beyond Lithium in the Treatment of Bipolar Illness

Valproate Intoxication in a Patient With Blood Valproate Levels Within Therapeutic Range

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