Bipolar Disorder: Open Access
Open Access

Abstract

Bipolar Disorders and Valproate: Pharmacokinetics, Pharmacodynamics, Therapeutic Effects and Indications of Valproate: Review of Articles

Getinet Ayano

Valproate is a mood stabilizer which is approved for use in acute and maintenance mania. It is the first line drug for bipolar patients with presence rapid cycling, irritable mania, bipolar disorder with comorbid substance use disorders, severe mania with psychosis, mixed mania and secondary mania.

The specific mechanism of action of valproate in stabilizing mood is unknown. It exerts effects by enhancement of brain γ-aminobutyric acid (GABA) levels via multiple actions of synthesis and degradation, and modulation of other neurotransmitters, voltage sensitive Na+ channels, extra hypothalamic neuropeptides, secondary messenger systems, and neuro protection.

Common side effects include gastrointestinal (GI) distress, tremor, sedation, hair loss, increased appetite and weight gain. Hepatic failure, pancreatitis, and hyperammonemic encephalopathy are rare serious side effects associated with use of valproate. Routine blood level monitoring is not necessary. There is an increased risk of fetal abnormalities if valproateis taken in pregnancy.

Valpraote concentrations are known to be increased with concurrent use of benzodiazepines, non-steroidal antiinflammatory drugs (NSAIDS) such as spirin, cemitidine and erythrpmycin. Its level decrease when administrated with phenobarbitone, phenytoin and carbamazepine.