Valproic acid
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Valproic acid Peripheral oedema: 2 case reports Two patients developed peripheral oedema during treatment with valproic acid.* A 39-year-old woman, who had a history of paranoid schizophrenia, developed worsening psychotic symptoms despite treatment with risperidone for 1 month. She was hospitalised and her risperidone dosage was increased. However, 13 days later, her symptoms had not improved and she started receiving oral valproic acid 1000 mg/day. After 7 days, she developed moderate pitting pedal oedema on her bilateral lower extremities. At this time, her valproic acid serum concentration was 52.2 µg/mL. Valproic acid was stopped and, within 3 days, her bilateral pedal oedema decreased rapidly. Valproic acid 1000 mg/day was restarted, but she again developed bilateral pedal oedema. Her oedema then resolved after valproic acid discontinuation. A 45-year-old woman, who had a history of bipolar disorder, was hospitalised with a relapse of her mania due to poor medical adherence. Four days before hospitalisation, she had started receiving valproic acid [dosage not stated] and risperidone. At hospitalisation, her average serum valproic acid concentration was 84 µg/mL and she had developed pedal oedema (right foot 1+; left foot 2+). Risperidone was replaced by sulpiride on hospital day 9. However, on day 17, her oedema had not improved and, on day 19, sulpiride was replaced by carbamazepine, after which the oedema started to improve. She was subsequently discharged, at which time her oedema had almost disappeared. During an outpatient follow-up, she reported that her lower leg oedema recurred within 1 week after she had received a prescription from another medical service. She had then discontinued the drugs and her oedema had subsided. An examination of the previous prescription revealed another undisclosed exposure to valproic acid. Author comment: "[T]he temporal course of events described suggest an association between adjunctive use of [valproic acid] and the development of peripheral oedema." * the drug name was rendered as valproate in the paper Lin ST, et al. Valproate-related peripheral oedema: a manageable but probably neglected condition. International Journal of Neuropsychopharmacology 12: 801154978 991-993, No. 7, Aug 2009 - Taiwan
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Reactions 16 Jan 2010 No. 1284
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