Disease relevance of VALPROIC ACID

• The average weight gain with olanzapine treatment was 2.5 kg, compared to 0.9 kg with divalproex treatment [1].
• Anticonvulsant hypersensitivity syndrome from addition of lamotrigine to divalproex [2].
• Successful treatment of persistent migraine aura with divalproex sodium [3].
• We report a patient with dialysis-induced encephalopathy who was taking divalproex sodium for a seizure disorder [4].
• PATIENTS AND METHODS: Patients who had not previously had a seizure were randomized within 14 days of diagnosis of their brain tumor to receive either divalproex sodium or placebo [5].

Psychiatry related information on VALPROIC ACID

• Divalproex was superior to lithium in longer duration of successful prophylaxis in the study and less deterioration in depressive symptoms and Global Assessment Scale scores [6].
• METHOD: Sixty-five hospitalized patients who met the Research Diagnostic Criteria for bipolar disorder with mania were treated with divalproex, 750 mg/day for 2 days and then 1,000 mg/day on days 3-5; the dosage was subsequently adjusted as clinically indicated for the remainder of the 21-day study [7].
• Impact of trait impulsivity and state aggression on divalproex versus placebo response in borderline personality disorder [8].
• Differential effect of number of previous episodes of affective disorder on response to lithium or divalproex in acute mania [9].
• Pilot comparison of extended-release and standard preparations of divalproex sodium in patients with bipolar and schizoaffective disorders [10].

High impact information on VALPROIC ACID

• Patients treated with divalproex had better outcomes than those treated with placebo or lithium on several secondary outcome measures [6].
• METHOD: An 8-week open-label trial of divalproex sodium to control manic symptoms and to discern the effect of divalproex sodium on ADHD was followed by a 4-week randomized, double-blind, placebo-controlled crossover trial to determine if mixed amphetamine salts was safe and effective for treatment of ADHD symptoms [11].
• A 20-month, double-blind, maintenance trial of lithium versus divalproex in rapid-cycling bipolar disorder [12].
• After other variables were controlled by multiway analysis of variance, the hospital stay of patients who continued the initial medication was 15.2% longer (2.0 days) for divalproex than valproic acid [13].
• Treatment-emergent adverse events occurring significantly more frequently during olanzapine treatment were somnolence, dry mouth, increased appetite, weight gain, akathisia, and high alanine aminotransferase levels; those for divalproex were nausea and nervousness [14].

Chemical compound and disease context of VALPROIC ACID

• Valproic acid and its enteric-coated derivative, divalproex sodium, have been used extensively in a wide variety of seizure disorders [15].
• RESULTS: Migraine frequency was reduced in 19% (6/ 32) of placebo-treated, 66% (21/32) of divalproex-treated, and 63% (20/32) of propranolol-treated patients [16].
• Generalized edema with risperidone: divalproex sodium treatment [17].
• Four double-blind placebo-controlled studies have confirmed that divalproex sodium/valproate is an effective migraine treatment [18].
• Gabapentin was the most costly at dollars 138.00 per migraine prevented, whereas the cost per migraine prevented with topiramate was US dollars 114.80 and with divalproex sodium was US dollars 48.00 [19].

Biological context of VALPROIC ACID

• With Theo-Dur Sprinkle the bioavailability was reduced to 44%, and the absorption profiles became unpredictable with marked interindividual variations [20].
• METHODS: The effect of concomitant administration of divalproex sodium on the pharmacokinetics of amitriptyline and its active metabolite, nortriptyline, was investigated in an open-label, sequential, two-period phase I study [21].
• CONCLUSIONS: Divalproex was not significantly more effective than monitoring without drug for the prevention of postpartum episodes of bipolar disorder [22].
• SETTING: Eight headache/neurology clinics throughout the United States. PATIENTS: One hundred seven patients randomized to divalproex or placebo (2:1 ratio): 70 receiving divalproex and 37 receiving placebo [23].
• Divalproex decreased marijuana craving during abstinence, yet increased ratings of 'anxious', 'irritable', 'bad effect', and 'tired.' Divalproex worsened performance on psychomotor tasks, and increased food intake regardless of marijuana condition [24].

Anatomical context of VALPROIC ACID

• OBJECTIVE: To determine outcome in patients with intractable frontal lobe seizures who were treated with the combination of divalproex and lamotrigine [25].
• Ovarian ultrasound revealed an increased number of ovarian follicles in 1 patient taking lithium and in none of the patients taking divalproex [26].
• Divalproex sodium provided complete relief, suggesting the headache is attributable to cell membrane instability [27].
• Effects of divalproex and atypical antipsychotic drugs on dopamine and acetylcholine efflux in rat hippocampus and prefrontal cortex [28].
• Based on open studies and expert panel recommendations, the International Exchange on Bipolar Disorder (IEBD) recommended initial treatment with divalproex sodium, with subsequent addition of other mood stabilizers, antipsychotics or thyroid supplementation as necessary [29].

Associations of VALPROIC ACID with other chemical compounds

• This study assessed presynaptic dopamine function in neuroleptic- and mood-stabilizer-naive nonpsychotic first-episode manic patients before and after treatment with divalproex sodium by measuring [(18)F]6-fluoro-L-dopa ([(18)F]DOPA) uptake in the striatum with positron emission tomography (PET) [30].
• The bioavailability and absorption pattern of theophylline from Theo-Dur Sprinkle were investigated in adults both in fasting conditions and after two different meals [31].
• The authors designed a 21-day prospective, double-blind, randomized, placebo-controlled pilot study of divalproex sodium as add-on treatment to haloperidol in 12 hospitalized patients with acute exacerbations of chronic schizophrenia [32].
• Effects of divalproex sodium on 5-HT1A receptor function in healthy human males: hypothermic, hormonal, and behavioral responses to ipsapirone [33].
• To examine the effects of divalproex sodium (DVP) on 5-HT1A receptor function in humans, we measured the hypothermic, adrenocorticotropic hormone (ACTH) cortisol, and behavioral responses to ipsapirone in 10 healthy male volunteers [33].

Gene context of VALPROIC ACID

• CYP2C19 induction by ginkgo could be a plausible explanation for the subtherapeutic levels of Dilantin and Depakote [34].
• The following agents were used ACTH (n = 14), prednisone (n = 12), IV IgG (n = 6), immuran (n = 2), depakote (n = 1), and inderal (n = 1) [35].
• Randomized, placebo-controlled trial of mixed amphetamine salts for symptoms of comorbid ADHD in pediatric bipolar disorder after mood stabilization with divalproex sodium [11].
• This study demonstrates the efficacy of divalproex sodium as monotherapy for the treatment of partial-onset seizures and supports its role as one of the first-line antiepileptic drug treatments for patients with partial epilepsy [36].
• BACKGROUND: The aim of this study was to evaluate the efficacy of divalproex (VLP) to prevent episode recurrence in postpartum women with bipolar disorder [22].

Analytical, diagnostic and therapeutic context of VALPROIC ACID

• METHOD: This 47-week, randomized, double-blind study compared flexibly dosed olanzapine (5-20 mg/day) to divalproex (500-2500 mg/day) for manic or mixed episodes of bipolar disorder (N=251) [14].
• Divalproex treatment for youth with explosive temper and mood lability: a double-blind, placebo-controlled crossover design [37].
• Ten of the 13 patients had repeat PET scans 2-6 weeks after beginning treatment with divalproex sodium monotherapy [30].
• Initial treatment with divalproex prolonged length of stay by 30.3% in patients treated with divalproex and valproic acid during different admissions [13].
• After treatment with divalproex sodium, [(18)F]DOPA rate constants were significantly reduced in the patients and were lower in the patients than in the comparison subjects [30].

References