Consider Valproic Acid for Hyperactive Delirium

By Osterweil, Neil | Clinical Psychiatry News, June 2014 | Go to article overview

Consider Valproic Acid for Hyperactive Delirium


Osterweil, Neil, Clinical Psychiatry News


AT THE APA ANNUAL MEETING

NEW YORK -- Valproic acid might be effective for treating hyperactive delirium, results of a small, retrospective study suggest.

Among 16 patients with hyperactive delirium, 13 had complete resolution of delirium according to the DSM-IV-TR criteria, reported Dr. Yelizaveta I. Sher, an instructor in psychiatry and behavioral science at Stanford (Calif.) University.

Delirium is the most frequent psychiatric diagnosis in general hospital settings and has been reported to occur in up to 85% of patients in intensive care units (ICUs), she noted.

"It prolongs hospital stays and significantly increases morbidity and mortality of these patients," Dr. Sher said at the annual meeting of the American Psychiatric Association.

Antipsychotic agents are usually first-line pharmacological therapies for delirium, but these agents are sometimes ineffective in this setting, and are associated with adverse events such as prolongation of the QT interval, and with extrapyramidal side effects such as akathisia, tremors, and, less frequently, the neuroleptic malignant syndrome, Dr. Sher said.

Antispychotics also are less-than-ideal agents for treatment of agitation associated with acute delirium after traumatic brain injury or from alcohol withdrawal, she added.

Valproic acid is the most widely used agent for the treatment of seizures worldwide, and is approved in the United States for seizures, migraine prophylaxis, and acute manic or mixed bipolar episodes. It often is used off label for treatment of agitation, neuropathic pain, and personality disorder, according to Dr. Sher.

Also, its use has been explored in agitated patients with dementia, agitation in traumatic brain injury, and corticosteroid-induced mania.

The use of valproic acid has been associated with neural tube defects in fetuses and must be avoided in women who are pregnant. It also has been associated with mild blood dyscrasias, abnormal liver function tests, and, in patients with urea-cycle enzyme deficiencies, symptomatic hyperammonemia, Dr. Sher said.

Medication interactions with valproic acid include a decrease in blood levels of up to 80% when it is used with meropenem, and an increase in warfarin levels when valproic acid is used with the anticoagulant. Valproic acid also can decrease clearance of carbamazepine, lamotrigine, nortriptyline, and amitriptyline. …

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