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Epilepsy
Published in Ibrahim Natalwala, Ammar Natalwala, E Glucksman, MCQs in Neurology and Neurosurgery for Medical Students, 2022
Ibrahim Natalwala, Ammar Natalwala, E Glucksman
vi - Ethosuximide. The typical EEG finding is that seen in patients suffering absence seizures. The first-line treatment is usually ethosuximide. Sodium valproate can be considered if there is a high risk of generalised tonic-clonic seizures as well as absence seizures.
The patient with acute neurological problems
Published in Peate Ian, Dutton Helen, Acute Nursing Care, 2020
Pharmacological management includes the use of traditional anti-epileptic medications such as phenytoin, or more modern agents, such as levetiracetam (Keppra), lamotrigine, sodium valproate and topiramate, which have proven to be effective in generalised epilepsy. However, safety advice should be considered when using sodium valproate in young women and girls of childbearing age (Medicines and Healthcare products Regulatory Authority [MHRA] 2018).
Neurology
Published in Kristen Davies, Shadaba Ahmed, Core Conditions for Medical and Surgical Finals, 2020
Vanessa is a 27-year-old woman who suffers with generalised tonic–clonic seizures that are managed with sodium valproate. Name two side effects of sodium valproate.Vanessa is interested in driving again. How long does she need to be seizure free before being able to drive?
Comparing the efficacy of aripiprazole as an add-on to valproate with other second-generation antipsychotics in acute mania symptoms in manic patients in Iran
Published in International Journal of Psychiatry in Clinical Practice, 2022
Zeinab Sadat Ayatollahi, Mehran Shayganfard, Hamidreza Jamilian, Anita Alaghmand
In the intervention group, patients treated with aripiprazole received a basal dose of 5–15 mg per day, which was increased by 5 mg at weeks 2, 4 and 6 (maximum dose at the end of the 6th week: 30 mg per day) (Arnold et al. 2021). Risperidone treatment was initiated with 2–3 mg per day increased to the maximum dose of 6 mg per day (the dose elevation was not more than 1 mg per day). Firstly, olanzapine treatment was administered in 10–15 mg daily maximised to 20–25 mg daily at the end. 100 mg quetiapine was prescribed for the first day which was increased 100 mg per day until the fourth day (400 mg on the fourth day). Then, it was increased on days 5th and 6th (200 mg daily) reached 800 mg on the sixth day. Treatment with sodium valproate was started orally at a dose of 250 mg which was eventually increased to 1200–1500 mg daily in divided doses. To perform an equal treatment plan in both groups, the only mood stabiliser which was added over Aripiprazole or other second-generation antipsychotics was sodium valproate.
Comparative analysis of the use and control of thalidomide in Brazil and different countries: is it possible to say there is safety?
Published in Expert Opinion on Drug Safety, 2022
Soraya Machado de Jesus, Rafael Santos Santana, Silvana Nair Leite
Some feasibility studies of the PPP for thalidomide, developed in the US, have indicated satisfactory results, considering the non-occurrence of pregnancy during the use of the drug by women of childbearing age. However, studies have also pointed out that such systems have the potential to affect access, due to the rigor of controls. An example of this is the control of isotretinoin use. Research in the US that evaluated of patients using isotretinoin, identified that there were pregnancy rates during treatments. However, more stringent PPP do not guarantee better results in pregnancy exposure rates, as occurrences have been recorded during treatment, even if in smaller numbers [24,27,33,35–37,42]. In the US, sodium valproate, for example, is a drug that has restricted indications for women of childbearing age but still records cases of birth defects [79,127].
Factors influencing lithium versus valproate prescription preference in the maintenance treatment of bipolar patients: a report from the Italian Early Career Psychiatrists (SOPSI-GG)
Published in International Journal of Psychiatry in Clinical Practice, 2021
Massimiliano Buoli, Eleonora Gattoni, Enrico Collantoni, Alessio Maria Monteleone, Marco Solmi, Luisa Longo, Michele Ribolsi, Jacopo Santambrogio, Francesco Saverio Bersani, Andrea Aguglia, Gianluca Serafini, Maria Salvina Signorelli, Bernardo Dell’Osso, Mario Luciano, Silvana Galderisi
Sodium valproate is a drug approved in many countries for the treatment and/or prevention of manic and mixed mood states. It has shown to be particularly effective in patients with no response to lithium and/or with rapid-cycling (Swann et al. 1999; Yatham 2004). Compared to valproate, lithium seems to be more efficacious in prevention of recurrences (Cipriani et al. 2013) and in bipolar patients with suicidal ideation or a history of suicidal attempts (Schaffer et al. 2015). Regarding safety, while the use of valproate in pregnancy has raised relevant concerns (Andrade 2018) and the use of this compound is contraindicated in women of childbearing age with the exception of cases with poor response or tolerability to previous treatments for BD (Paton et al. 2018), lithium does not seem to clinically increase the number of newborns’ malformations, with a clearly favourable risk/benefit ratio in pregnant women suffering from BD (Cohen et al. 2019; Fornaro et al. 2020). Both drugs need regular monitoring of serum levels in light of a great variability in pharmacokinetic parameters after oral administration, and due to the narrow therapeutic index of lithium. In addition, both compounds may be associated with serious adverse events including arrhythmia or seizures for lithium or thrombocytopenia or liver failure for valproate (Buoli et al. 2018). Furthermore, some authors argue that valproate may have limited efficacy in the long-term treatment of BD (Cipriani et al. 2013) in face of the potential serious side effects that characterise especially genetically predisposed subjects (Zhu et al. 2017).