Pericardial and Pleural Effusion with Valproic Acid use in a Patient with Bipolar Disorder

Background: Lamotrigine is a phenyltriazine medication that has been approved by the United States Food and Drug Administration as monotherapy and as an adjunctive agent for the treatment of seizure disorder. It was later approved by the FDA for the treatment of bipolar disorder. Lamotrigine is generally well tolerated by patients, but some serious symptoms can occur during treatment. These severe side effects include rashes and multi-organ failure. Lamotrigine has also been associated with the development of mental status changes, frequently when used concurrently with other medications that may impact the metabolism of lamotrigine. Objective: To present the case of a 65-year-old man being treated with lamotrigine and valproic acid who developed mental status changes after the addition of sertraline to his medication regimen, and to compare this case to existing cases reported in the literature. Discussion: Our case adds to the existing literature by demonstrating that patients may experience adverse medication effects despite lamotrigine levels that are normally considered to be in the therapeutic range, highlighting the importance of clinical correlation when obtaining medication levels. Conclusion: Clinicians should use caution interpreting lamotrigine levels when working up delirium, as normal levels may not rule out the development of lamotrigine toxicity.

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Possible Interaction Between Lopinavir/Ritonavir And Valproic Acid Exacerbates Bipolar Disorder

Annals of Pharmacotherapy ◽

10.1345/aph.1g418 ◽

2006 ◽

Vol 40 (1) ◽

pp. 147-150 ◽

Cited By ~ 23

Author(s):

Nancy L Sheehan ◽

Marie-Josée Brouillette ◽

Marie-Soleil Delisle ◽

James Allan

Keyword(s):

Bipolar Disorder ◽

Valproic Acid

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Neural network dysfunction in bipolar depression: clues from the efficacy of lamotrigine

Biochemical Society Transactions ◽

10.1042/bst0371080 ◽

2009 ◽

Vol 37 (5) ◽

pp. 1080-1084 ◽

Cited By ~ 12

Author(s):

Charles H. Large ◽

Elena Di Daniel ◽

Xingbao Li ◽

Mark S. George

Keyword(s):

Bipolar Disorder ◽

Valproic Acid ◽

Protein Kinase ◽

Glycogen Synthase ◽

Bipolar Depression ◽

Inhibitory Effect ◽

Mood Stabilizers ◽

Mitogen Activated Protein Kinase ◽

Facilitatory Effect

One strategy to understand bipolar disorder is to study the mechanism of action of mood-stabilizing drugs, such as valproic acid and lithium. This approach has implicated a number of intracellular signalling elements, such as GSK3β (glycogen synthase kinase 3β), ERK (extracellular-signal-regulated kinase)/MAPK (mitogen-activated protein kinase) or protein kinase C. However, lamotrigine does not seem to modulate any of these targets, which is intriguing given that its profile in the clinic differs from that of valproic acid or lithium, with greater efficacy to prevent episodes of depression than mania. The primary target of lamotrigine is the voltage-gated sodium channel, but it is unclear why inhibition of these channels might confer antidepressant efficacy. In healthy volunteers, we found that lamotrigine had a facilitatory effect on the BOLD (blood-oxygen-level-dependent) response to TMS (transcranial magnetic stimulation) of the prefrontal cortex. This effect was in contrast with an inhibitory effect of lamotrigine when TMS was applied over the motor cortex. In a follow-up study, a similar prefrontal specific facilitatory effect was observed in a larger cohort of healthy subjects, whereas valproic acid inhibited motor and prefrontal cortical TMS-induced BOLD response. In vitro, we found that lamotrigine (3–10 μM) enhanced the power of gamma frequency network oscillations induced by kainic acid in the rat hippocampus, an effect that was not observed with valproic acid (100 μM). These data suggest that lamotrigine has a positive effect on corticolimbic network function that may differentiate it from other mood stabilizers. The results are also consistent with the notion of corticolimbic network dysfunction in bipolar disorder.

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Diacylglycerol kinase (DGKA) regulates the effect of the epilepsy and bipolar disorder treatment valproic acid inDictyostelium discoideum

Disease Models & Mechanisms ◽

10.1242/dmm.035600 ◽

2018 ◽

Vol 11 (9) ◽

pp. dmm035600 ◽

Cited By ~ 5

Author(s):

Elizabeth Kelly ◽

Devdutt Sharma ◽

Christopher J. Wilkinson ◽

Robin S. B. Williams

Keyword(s):

Bipolar Disorder ◽

Valproic Acid ◽

Diacylglycerol Kinase ◽

Disorder Treatment

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Decreased NOX2 expression in the brain of patients with bipolar disorder: association with valproic acid prescription and substance abuse

Translational Psychiatry ◽

10.1038/tp.2017.175 ◽

2017 ◽

Vol 7 (8) ◽

pp. e1206-e1206 ◽

Cited By ~ 9

Author(s):

T Seredenina ◽

S Sorce ◽

F R Herrmann ◽

X-J Ma Mulone ◽

O Plastre ◽

...

Keyword(s):

Bipolar Disorder ◽

Substance Abuse ◽

Valproic Acid ◽

The Brain

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General pharmacokinetic/pharmacodynamic concepts of mood stabilizers in the treatment of bipolar disorder

Mental Health Clinician ◽

10.9740/mhc.2016.01.054 ◽

2016 ◽

Vol 6 (1) ◽

pp. 54-61 ◽

Cited By ~ 2

Author(s):

Kenric Ware ◽

Erika Tillery ◽

Lauren Linder

Keyword(s):

Bipolar Disorder ◽

Valproic Acid ◽

Mood Stabilizer ◽

Patient Characteristics ◽

Well Being ◽

Mood Stabilizers ◽

Medline Search ◽

Recommended Treatment ◽

Clinical Databases ◽

Mitigating Factors

Abstract Introduction Mood stabilizers are the recommended treatment for patients who receive a diagnosis of bipolar disorder. Because of the necessity of mood stabilizer treatment in patients with bipolar disorder and the extent of pharmacokinetic and pharmacodynamic principles involved, the purpose of this review is to summarize the pharmacokinetic principles of lithium in addition to the pharmacodynamics of lithium, carbamazepine, lamotrigine, and valproic acid/valproate. Methods Practice guidelines, review articles, and clinical trials were located using online databases PubMed, CINAHL, IDIS, and Medline. Search terms included at least one of the following: bipolar disorder, carbamazepine, lamotrigine, lithium, mood stabilizers, pharmacokinetics, pharmacodynamics, valproate, and valproic acid. Online clinical databases Dynamed® and Lexicomp® were also used in the study. Results Mood stabilizers collectively possess distinct qualities that are closely regarded before, during, and after therapeutic initiation. Individual patient characteristics, coupled with these observed traits, add to the complexity of selecting the most optimal neurologic agent. Each medication discussed uniquely contributes to both the maintenance and restoration of overall patient well-being. Discussion Introduction of mood stabilizers into drug regimens is often done in the presence of an array of mitigating factors. Safety and efficacy measures are commonly used to gauge desired results. Careful monitoring of patients' responses to selected therapies is paramount for arriving at appropriate clinical outcomes.

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