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Persistent low concentrations of antiepileptics in a critically ill paediatric patient: an example of multiple potential drug interactions.
BMJ Case Rep
January 2025
Clinical Pharmacology, Aalborg University Hospital, Aalborg, Region Nordjylland, Denmark
A middle childhood boy with epilepsy exhibited persistent low concentrations of valproic acid, lamotrigine and topiramate for over 1 month, primarily due to pharmacokinetic interactions involving fosphenytoin, meropenem and phenobarbital. Awareness of these clinically significant interactions is crucial for ensuring effective seizure control. However, further research is needed to establish optimal evidence-based treatment strategies in complex paediatric cases.
View Article and Find Full Text PDFEffect of Valproate Coprescription on Clozapine Pharmacokinetics in Clinical Practice.
J Clin Psychopharmacol
January 2025
Department of Psychological Medicine, University of Otago, Wellington, New Zealand.
Background: Sodium valproate has been coprescribed with clozapine for seizure prophylaxis and for augmentation in treatment-refractory schizophrenia. However, the effect of valproate on clozapine metabolism and on the incidence of clozapine-related side effects is unclear.
Methods: We compared clozapine dose and plasma clozapine and N-desmethylclozapine (norclozapine) concentrations in smokers and nonsmokers of both sexes in samples submitted for clozapine therapeutic drug monitoring, 1996-2017 in relation to valproate coprescription.
Clinical efficacy and safety of vortioxetine as an adjuvant drug for patients with bipolar depression.
J Zhejiang Univ Sci B
January 2025
Department of Psychiatry, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.
Objectives: Whether vortioxetine has a utility as an adjuvant drug in the treatment of bipolar depression remains controversial. This study aimed to validate the efficacy and safety of vortioxetine in bipolar depression.
Methods: Patients with bipolar Ⅱ depression were enrolled in this prospective, two-center, randomized, 12-week pilot trial.
A case report of exacerbation of extrapyramidal symptoms following the switch from risperidone to paliperidone during valproate therapy.
BMC Psychiatry
January 2025
Department of Psychiatry, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-Ku, Yokohama, Kanagawa, 236-0004, Japan.
Background: Paliperidone is a second-generation antipsychotic and the main active metabolite of risperidone, formulated to provide consistent therapeutic effects through an extended-release system, designed to provide consistent therapeutic effects through an extended-release formulation. While commonly used in clinical practice, switching from risperidone to paliperidone, particularly during valproate therapy, can pose challenges due to potential pharmacokinetic interactions that may increase the risk of extrapyramidal symptoms (EPS). Despite clinical observations suggesting these interactions, case reports documenting such adverse effects are scarce.
View Article and Find Full Text PDFOutpatient Management of Bipolar Disorder in Older Adults.
Curr Psychiatry Rep
February 2025
Department of Psychiatry and Behavioral Sciences, Dell Medical School, The University of Texas at Austin, AMG Seton Behavioral Health, 1301 W. 38th Street, Suite 700, Austin, TX, 78757, USA.
Article Synopsis
- Older adults with bipolar disorder (OABD) face unique challenges in diagnosis and treatment, particularly in outpatient settings.
- Mood episodes in OABD are similar in frequency and severity to those in younger adults, with depression being more common and mixed symptoms frequent.
- Effective treatment may involve using lower doses of lithium over other medications, and clinicians should focus on managing medical comorbidities and reducing the number of medications prescribed.
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