Treatment of valproate tremors

Karas, Barry J.; Wilder, B. J.; Hammond, E. J.; Bauman, Arthur W.

doi:10.1212/wnl.33.10.1380

Cited by 46 publications

(20 citation statements)

References 0 publications

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“…Tremor can be a significant cause of frustration for many patients, and is experienced by up to 10% of those treated with lithium or divalproex 668, 856, 857. New onset neurological symptoms in patients on divalproex should raise suspicion of hyperammonaemic encephalopathy, which, while rare, can be potentially fatal, and hence early detection and discontinuation of divalproex is critical to prevent morbidity and mortality858 Sustained release formulations and dose reductions may limit symptoms 802, 859, 860.…”

Section: Safety and Monitoringmentioning

confidence: 99%

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

et al. 2018

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The Canadian Network for Mood and Anxiety Treatments (CANMAT) previously published treatment guidelines for bipolar disorder in 2005, along with international commentaries and subsequent updates in 2007, 2009, and 2013. The last two updates were published in collaboration with the International Society for Bipolar Disorders (ISBD). These 2018 CANMAT and ISBD Bipolar Treatment Guidelines represent the significant advances in the field since the last full edition was published in 2005, including updates to diagnosis and management as well as new research into pharmacological and psychological treatments. These advances have been translated into clear and easy to use recommendations for first, second, and third‐ line treatments, with consideration given to levels of evidence for efficacy, clinical support based on experience, and consensus ratings of safety, tolerability, and treatment‐emergent switch risk. New to these guidelines, hierarchical rankings were created for first and second‐ line treatments recommended for acute mania, acute depression, and maintenance treatment in bipolar I disorder. Created by considering the impact of each treatment across all phases of illness, this hierarchy will further assist clinicians in making evidence‐based treatment decisions. Lithium, quetiapine, divalproex, asenapine, aripiprazole, paliperidone, risperidone, and cariprazine alone or in combination are recommended as first‐line treatments for acute mania. First‐line options for bipolar I depression include quetiapine, lurasidone plus lithium or divalproex, lithium, lamotrigine, lurasidone, or adjunctive lamotrigine. While medications that have been shown to be effective for the acute phase should generally be continued for the maintenance phase in bipolar I disorder, there are some exceptions (such as with antidepressants); and available data suggest that lithium, quetiapine, divalproex, lamotrigine, asenapine, and aripiprazole monotherapy or combination treatments should be considered first‐line for those initiating or switching treatment during the maintenance phase. In addition to addressing issues in bipolar I disorder, these guidelines also provide an overview of, and recommendations for, clinical management of bipolar II disorder, as well as advice on specific populations, such as women at various stages of the reproductive cycle, children and adolescents, and older adults. There are also discussions on the impact of specific psychiatric and medical comorbidities such as substance use, anxiety, and metabolic disorders. Finally, an overview of issues related to safety and monitoring is provided. The CANMAT and ISBD groups hope that these guidelines become a valuable tool for practitioners across the globe.

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Section: Safety and Monitoringmentioning

confidence: 99%

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

et al. 2018

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show abstract

“…5 The occurrence of tremor is found to be more associated with valproate dose than plasma concentration 14 Beta blockers are often utilized as a firstline pharmacologic intervention for valproate tremor. 15 Tremors also arise in healthy individuals under conditions of stress or fatigue and thus may not signal the presence of disease. Traditional assessments of tremor severity often employ several tasks such as handwriting, finger-tonose testing and drawing Archimedes spirals.…”

Section: Discussionmentioning

confidence: 99%

Comparison of tremor induced by valproate and lithium in bipolar disorder using a hand steadiness tester

Sengupta

Guha

Banerjee

et al. 2014

Int J Basic Clin Pharmacol

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“…71 Treatment with propranolol can be beneficial. 82 Other tremorogenic medications include anti-arrhythmics, bronchodilators, and chemotherapeutic agents. 83, 84 Drugs of abuse such as alcohol, cocaine, and amphetamines can also cause tremor, due to acute intoxication, chronic use, or withdrawal.…”

Section: Drug-induced Tremormentioning

confidence: 99%