Olanzapine/valproic acid interaction. Hypersalivation in an elderly patient: case report. A 75-year-old woman developed hypersalivation during concomitant ...
Reactions 1350 - 7 May 2011
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Olanzapine/valproic acid interaction Hypersalivation in an elderly patient: case report A 75-year-old woman developed hypersalivation during concomitant therapy with olanzapine and valproic acid* for bipolar disorder [routes not stated]. The woman was hospitalised with agitation and grandiosity; at that time, she was receiving multiple medications including olanzapine 2.5mg [frequency not stated], which she had been receiving for an unspecified duration. All other drugs were stopped, and olanzapine was gradually increased to a dosage of 10 mg/day. However, her symptoms persisted, and olanzapine was further increased to 15 mg/day, and valproic acid 1000 mg/day was added to her therapy. She reported hypersalivation after 4 days of concomitant therapy; sialorrhoea became more prominent, interfering with her ability to speak and requiring her to continuously hold a cloth during the interviews. Hypersalivation did not occur while she was sleeping. Manic symptoms and hypersalivation persisted after 10 days of concomitant therapy with olanzapine and valproic acid. Valproic acid was discontinued, and the woman started undergoing electroconvulsive therapy (ECT). Her hypersalivation resolved over the next week, and her manic symptoms improved after eight ECT sessions. Valproic acid was restarted after ECT completion. On discharge, the woman was receiving olanzapine 5 mg/day and valproic acid 1000 mg/day, without recurrence of hypersalivation. Author comment: "Since hypersalivation occurred only when olanzapine was increased to 15 mg/day and after the introduction of valproate 1,000 mg/day, this side effect could be secundary to the olanzapine dose itself, to valproate introduction, or to the interaction of both psychopharmacs." * personal communication with the author confirmed that valproic acid was the specific form of valproate the patient received. Kieling C, et al. Hypersalivation associated with olanzapine and valproate combination: A case report. CNS Spectrums 16: No. 3, 2011 - Brazil
