Status Epilepticus Associated with the Combination of Valproic Acid and Clomipramine

DeToledo, John C.; Haddad, Heskel M.; Ramsay, R. Eugene

doi:10.1097/00007691-199702000-00012

Cited by 32 publications

(17 citation statements)

References 11 publications

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“…Valproate inhibits the hepatic metabolism of certain drugs leading to an increase in their plasma concentrations. Examples include clomipramine [15] and lamotrigine [16]. A slower upward dose titration of these drugs is required if they are started in patients who are prescribed valproate.…”

Section: Drug Interactionsmentioning

confidence: 99%

A review of valproate in psychiatric practice

Haddad

Das

Ashfaq

et al. 2009

Expert Opinion on Drug Metabolism & Toxicology

122

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Valproate (2-propylpentanoate) is available as valproic acid, sodium valproate and semisodium valproate. It has actions on dopamine, GABA and glutamate neurotransmission and intracellular signaling. Its main psychiatric use is to treat bipolar disorder. It has been used in other psychiatric disorders, including schizophrenia and borderline personality disorder, but data are insufficient to recommend this. In acute mania, valproate monotherapy has similar efficacy to antipsychotic drugs and lithium whereas the combination of valproate and an antipsychotic is more effective than either drug alone. In maintenance treatment of bipolar disorder, valproate monotherapy has comparable efficacy to olanzapine although placebo-controlled evidence is limited. Maintenance treatment with valproate and quetiapine or olanzapine is more efficacious than valproate alone when an acute episode responds to the combination. Common adverse effects of valproate include weight gain, gastrointestinal symptoms, sedation, tremor and mild elevation of hepatic enzymes. Serious hepatic toxicity is rare in adults. Many adverse effects are dose related and resolve with dose reduction. Valproate is teratogenic and specifically associated with neural tube defect. Preliminary evidence has linked in utero exposure to decreased verbal intelligence in the offspring. These effects, plus a probable increased risk of polycystic ovary syndrome, limit valproate's use in women of childbearing potential.

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Section: Drug Interactionsmentioning

confidence: 99%

A review of valproate in psychiatric practice

Haddad

Das

Ashfaq

et al. 2009

Expert Opinion on Drug Metabolism & Toxicology

122

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“…As with the parent compound, the metabolites of many TCAs can lower seizure threshold. Drugs that inhibit the elimination of the TCA or its metabolites may precipitate seizures [57,60]. Several cases of TCA-induced status epilepticus have been reported, particularly with amitriptyline, imipramine and clomipramine.…”

Section: Drug-induced Seizuresmentioning

confidence: 99%

Changing Presentation of Seizures with Aging: Clinical and Etiological Factors

DeToledo

1999

Gerontology

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Background: The historically higher incidence of seizures in children has changed, the elderly now have a higher incidence than any age-group, 2–3 times of that found in children. Classical teachings on etiologies, clinical presentation and progression of seizures are based on observations of a younger population and need to be revised in view of features unique to this age-group. The findings of two large VA cooperative studies show that even in sophisticated medical environments, up to 30% of patients 60 years and older with recurrent partial seizures go undiagnosed for more than 1 year of seizure onset. Objective: (a) To characterize the manifestations of auras, seizures and postictal states in the elderly and the relevance of various etiologies to these presentations. (b) To identify and discuss factors that contribute to the difficulties in the diagnosis of seizures in this population. Methods: A review of our experience in treating a large population of elderly patients in a university epilepsy center and a review of the literature relating to the problem. Conclusions: Seizures in the elderly are both overdiagnosed and underdiagnosed: either situation can have serious adverse consequences. Diversity of etiologies and atypical presentations make recognition of seizures difficult. Histories are frequently inadequate: complaints of multiple physical symptoms confuse the picture, unwillingness of elderly patients to admit to problems they believe are physiological in nature by the fear others may think they are ‘losing their mind’ and high staff turnover result in erratic identification of problems. The significant morbidity and mortality associated with poorly controlled seizures in this population are in large part preventable since excellent response to treatment can be achieved in more than 80% of individuals. The correct diagnosis of seizures is more likely if both physician and patients are familiar with the nuances of epilepsy in the elderly.

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“…The same principles apply for VPA. VPA can inhibit several metabolic pathways involved in TCA metabolism but toxic levels have been reported only in some rare cases (25,26). Clinicians should therefore monitor patients and adjust dosages in individual cases rather than adopting systematic dose adjustments.…”

Section: The Effect Of Aeds On Antidepressantsmentioning

confidence: 99%

The pharmacological management of psychiatric comorbidities in patients with epilepsy

Mula

2016

Pharmacological Research

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Psychiatric disorders represent a frequent comorbidity in patients with epilepsy affecting quality of life, morbidity and mortality. Evidence-based data on the management of these conditions are limited but a number of recommendations are now available to guide clinical practice. The present paper reviews the pharmacological treatment of psychiatric problems in epilepsy with special attention to data coming from randomised controlled trials (RCTs), pharmacological interactions with AEDs and the issue of seizure worsening during treatment with psychotropic drugs. Epidemiologically or clinically relevant psychiatric conditions are discussed namely mood and anxiety disorders, psychoses and attention deficit hyperactivity disorder.

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Status Epilepticus Associated with the Combination of Valproic Acid and Clomipramine

Cited by 32 publications

References 11 publications

A review of valproate in psychiatric practice

A review of valproate in psychiatric practice

Changing Presentation of Seizures with Aging: Clinical and Etiological Factors

The pharmacological management of psychiatric comorbidities in patients with epilepsy

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