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Neutropenia induced by Valproic Acid: A case report

Published online by Cambridge University Press:  01 September 2022

N. Baldaquí ,
G. Anmella ,
S. Madero ,
F. Gutierrez ,
E. Pujal ,
L. Colomer  and
A. Giménez-Palomo
N. Baldaquí*
Affiliation:
Hospital Clínic de Barcelona, Bipolar And Depressive Disorders Unit, Institute Of Neuroscience, Barcelona, Spain
G. Anmella
Affiliation:
Hospital Clínic, Psychiatry, Barcelona, Spain
S. Madero
Affiliation:
Hospital Clínic de Barcelona, Institute Of Neuroscience, Barcelona, Spain
F. Gutierrez
Affiliation:
Hospital Clínic de Barcelona, Bipolar And Depressive Disorders Unit, Institute Of Neuroscience, Barcelona, Spain
E. Pujal
Affiliation:
Hospital Clínic de Barcelona, Bipolar And Depressive Disorders Unit, Institute Of Neuroscience, Barcelona, Spain
L. Colomer
Affiliation:
Hospital Clínic de Barcelona, Institute Of Neuroscience, Barcelona, Spain
A. Giménez-Palomo
Affiliation:
Hospital Clínic, Psychiatry, Barcelona, Spain
*
*Corresponding author.

Abstract

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Introduction

Valproic acid (VPA) is considered a well-tolerated antiepileptic drug used in Bipolar Disorder as a mood stabilizer. Nevertheless, VPA has been related to several adverse effects. Neutropenia is included as a potential adverse effect, although in clinical practice it is not often measured with regularity.

Objectives

To report a case of a patient with Bipolar Disorder type 2 and Personality Disorder Cluster B treated with VPA with a neutropenia caused by VPA.

Methods

A 61-year-old woman assists to the outpatient psychiatric unit in order to a pharmacological treatment adjustment. A blood test is performed showing a decrease in the levels of neutrophiles in comparison with previous tests. Psychiatric history is revised finding and association between the prescription of VPA and the reduction of neutrophile levels. When this drug was removed, neutrophile levels had increased again up to normal levels.

Results

Due to the relationship between neutropenia and VPA treatment, we decided to discontinue this drug. At the beginning the patient doesn’t agree with the withdrawal of VPA treatment due to its effectiveness in her mood stabilization. Psychoeducation sessions are performed in order to explain risk and benefits of potentials treatment alternatives versus maintaining the same prescription. Finally the patient accepts the switch of the mood stabilizer treatment to oxcarbazepine with a good tolerability and effectiveness.

Conclusions

Periodical blood test monitoring is needed in order to study adverse effects as neutropenia in patients with VPA treatment.

Disclosure

The author has received support from Janssen-Cilag, Otsuka-Lundbeck, Italfármaco, Angelini Pharma and Casen Recordati; and declares no support related to the subject of this article.

Keywords

bipolar disorderneutropeniavalproic acidadverse effect
Type
Abstract
Information
European Psychiatry , Volume 65 , Special Issue S1: Abstracts of the 30th European Congress of Psychiatry , June 2022 , pp. S731 - S732
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of the European Psychiatric Association
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