Off-Label Use of Sodium Valproate for Schizophrenia

Horowitz, Einav; Bergman, Lisa Carroll; Ashkenazy, Charna; Moscona-Hurvitz, Irit; Grinvald-Fogel, Haya; Magnezi, Racheli

doi:10.1371/journal.pone.0092573

Cited by 33 publications

(23 citation statements)

References 35 publications

(41 reference statements)

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“…In our study, comparison of PANSS score between two groups ie A and B, showed that in group B (olanzapine with sodium valproate) there was a statistically significant improvement in positive symptoms (p<0.014), general psychopathology (p<0.036) and total score (p<0.018) compared to group A (olanzapine and placebo). These findings were consistent with those of Horowitz E et al 5 and Ananthavarathan 6 who showed that sodium valproate helps to reduce aggressiveness and hostility in schizophrenia. Tseng et al 7 also found effectiveness of adjunctive sodium valproate in patients of schizophrenia.…”

Section: Discussionsupporting

confidence: 91%

“…Studies found that it may help to reduce aggressiveness and hostility in schizophrenia as an "off-label" use. 5,6 Tseng et al showed significantly better treatment effect with valproate augmentation therapy in patients with schizophrenia or schizoaffective disorder. 7 Omranifard et al found that sodium valproate speeds up the recovery of positive symptoms of schizophrenia.…”

Section: Introductionmentioning

confidence: 99%

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Effect of Adjunctive Sodium Valproate in Patients of Acute Schizophrenia

Saini¹,

Aggarwal²,

Pardal³

et al. 2019

IJCMR

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introduction: Sodium valproate is an anticonvulsant widely prescribed as a mood stabilizer for treating bipolar disorders. It's role in treating schizoaffective disorders is well documented. There are controversies regarding sodium valproate efficacy in schizophrenia. Although, some studies have reported that it is effective in the management of positive symptoms in acute psychosis, others have not found such an association. Study aimed at assessment the effect of adjunctive sodium valproate in acute stage of schizophrenia. Material and Methods:A total of 60 schizophrenic patients (age 18-45 years) were taken. They were randomly allocated into two groups, A and B. Patients in group A received atypical antipsychotic with placebo and in group B atypical antipsychotic with adjunctive sodium valproate. Olanzapine was taken as atypical antipsychotic in both groups. A diagnosis of schizophrenia was established based on ICD-10 DCR criteria. All patients were assessed by PANSS and CGI-S at baseline and at 6 weeks. The collected data were analyzed by Student and Paired t-tests through SPSS. results: Comparison of mean PANSS scores showed statistically significant improvement in positive symptoms (p<0.014), general psychopathology (p<0.036) and total score (p<0.018) in group B patients as compared to group A. CGI-S scores were also statistically significantly less in (p<0.011) group B patients as compared to group A after 6 weeks. conclusion:Our study shows that if used as an adjunctive to antipsychotic in the management of acute psychosis, sodium valproate will speed up the recovery of positive symptoms.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Effect of Adjunctive Sodium Valproate in Patients of Acute Schizophrenia

Saini¹,

Aggarwal²,

Pardal³

et al. 2019

IJCMR

View full text Add to dashboard Cite

show abstract

“…A review by Vargas-Espinosa et al mentions the use of valproate for PHN and makes a recommendation for a high-quality randomized controlled trial [29]. Studies have been conducted on valproate for indications other than epilepsy, on migraine, alcohol dependence, bipolar disorders, fibromyalgia, and schizophrenia with low evidence [29][30][31].…”

Section: Discussionmentioning

confidence: 99%

A Retrospective Study: The Off-Label Use of Anticonvulsants at a Private Hospital in Indonesia

Rahajeng

Ikawati

Andayani

et al. 2018

Int J Pharm Pharm Sci

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Objective: Anticonvulsant is one class of drugs often used off-label. This study was conducted to investigate the prevalence and the indication of the off-label use of anticonvulsants in a private hospital in Java, Indonesia. Methods:This was an observational study with a retrospective data collection in a private hospital in Java. Data were obtained on the prescription of anticonvulsants. Indications of the use of anticonvulsants were obtained from the medical records of patients who were prescribed anticonvulsants. The off-label use of anticonvulsants was defined a prescribing of medication outside the indication approved by The National Agency of Drug and Food Control Indonesia (NA-DFC). The use off-label of anticonvulsants was calculated by descriptive analysis and presented as a percentage.Results: It showed that in one year there were 5,310 for 1,316 patients: of this 462 patients (35.11%) were for an off-label use. The anticonvulsants used off-label were oxcarbazepine 67.27% (37/55), carbamazepine 46.15% (54/117), pregabalin45.45% (60/132), phenytoin37.62% (225/598), valproate 25.34% (37/109), and gabapentin 18.28% (49/219). The highest off-label use of anticonvulsants was found in neurological and psychiatric disorders 67.32% (n=311), and on 97.19% of them were not supported by strong clinical evidence. Conclusion:The off-label use of anticonvulsants occurred in one-third of patients receiving prescriptions of anticonvulsants, even though for most of them there was a lack of evidence. More attention must be paid to the efficacy and risk of side effects of the drug used.

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“…In contrast to bipolar disorder, however, robust empirical support for the efficacy of adjunctive treatment with MSMs in individuals with schizophrenia e.g., to mitigate residual psychotic symptoms, aggression, impulsivity, and mood disturbances, is lacking (Buchanan et al, 2010; Citrome 2009). Yet rates of prescribing of MSMs to individuals with schizophrenia are quite high, with an estimated 25–60% of patients receiving these agents (Citrome 2000; Citrome 2002; Horowitz et al, 2014; Olfson et al, 2009), Given the overall widespread use and the more frequent prescribing of high metabolic risk MSMs to individuals with schizophrenia, more research is needed to understand the potential harmful effects of such ‘off-label’ prescribing on the physical health of these individuals.…”

Section: Discussionmentioning

confidence: 99%

Gender differences in mood stabilizer medications prescribed to Veterans with serious mental illness

Charlotte

Schwartz

Slade

et al. 2015

Journal of Affective Disorders

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Background Mood stabilizer medications (MSMs) can induce significant weight gain and other metabolic side effects. Research suggests that women are more susceptible to psychotropic medication-induced metabolic side effects than men. We examined gender differences in the likelihood of receiving an MSM with a lower liability for weight gain using data from the U.S. Department of Veterans Affairs (VA) healthcare system. Methods We identified 3823 VA patients with a schizophrenia or bipolar disorder diagnosis who initiated treatment with a MSM between 10/2006 and 9/2011. We used multivariable logistic regression analysis to examine gender differences in the likelihood of incident prescription of MSMs with low versus medium/high metabolic risk, adjusting for fiscal year of prescribing and demographic, mental health, and physical health characteristics. Results Overall, 47% of women were prescribed a low metabolic risk MSM compared to 26% of men (p<0.0001). In multivariable analysis, women were 2.19 times as likely as men to be prescribed a low metabolic risk MSM (95% CI: 1.84–2.60, p<0.0001). Several demographic and clinical covariates were also independently related to prescribing of MSMs by level of metabolic risk. Limitations This study used retrospective administrative data collected from a VA healthcare system database, which does not allow us to understand the context in which MSM treatment decisions were made. Conclusions Prescribing choices for MSMs by VA mental health prescribers and female Veterans may reflect a growing awareness of the potential adverse health consequences of these treatments in women.

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Off-Label Use of Sodium Valproate for Schizophrenia

Cited by 33 publications

References 35 publications

Effect of Adjunctive Sodium Valproate in Patients of Acute Schizophrenia

Effect of Adjunctive Sodium Valproate in Patients of Acute Schizophrenia

A Retrospective Study: The Off-Label Use of Anticonvulsants at a Private Hospital in Indonesia

Gender differences in mood stabilizer medications prescribed to Veterans with serious mental illness

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