Related Experiment Video
Updated: Aug 14, 2026
04:42
Developing a Rat Model for Bipolar Disorder
Published on: May 2, 2025
Possible interaction between lopinavir/ritonavir and valproic Acid exacerbates bipolar disorder
Nancy L Sheehan1, Marie-Josée Brouillette, Marie-Soleil Delisle
1Faculty of Pharmacy, University of Montréal, Montréal, Québec, Canada. nancy.sheehan@umontreal.ca
The Annals of Pharmacotherapy
|December 22, 2005
Summary
Ritonavir-boosted antiretrovirals may decrease valproic acid (VPA) levels, potentially causing mania in bipolar disorder patients. Close monitoring of VPA concentrations is crucial when these drugs are used together.
Area of Science:
- Pharmacology
- Neuropsychiatry
- Infectious Diseases
Background:
- Bipolar disorder requires consistent mood stabilizer levels.
- HIV treatment often involves combination antiretroviral therapy.
- Valproic acid (VPA) is a common mood stabilizer for bipolar disorder.
Observation:
- A patient with bipolar disorder on VPA experienced exacerbated mania after initiating lopinavir/ritonavir.
- VPA levels decreased by 48% after starting antiretroviral therapy.
- Increasing the VPA dose and adding olanzapine led to clinical improvement.
Findings:
- Ritonavir may induce VPA glucuronidation, leading to lower VPA concentrations.
- This drug interaction is likely responsible for the patient's manic episode.
- A causality assessment indicated a probable link between decreased VPA levels and mania.
Implications:
- A potential interaction exists between VPA and ritonavir-boosted antiretroviral regimens.
- Clinicians must monitor VPA levels and effects in patients receiving these drug combinations.
- This highlights the importance of pharmacovigilance in managing complex patient cases.
Related Concept Videos
01:24Mania and Antimanic Drugs: Overview
Mania, a psychological condition characterized by elevated mood, increased energy, and reduced sleep need, is part of the bipolar disorder cycle. The exact cause of mania isn't entirely known, but it is thought to be a combination of genetic, environmental, and neurological factors. Bipolar disorder involves alternating manic and depressive episodes. Mood stabilizers like lithium, antipsychotics, and anticonvulsants help manage these episodes. Lithium carbonate is particularly effective as a...
01:26Pharmacokinetics: Drug–Food and Drug–Viral Interactions
A drug interaction occurs when the concurrent use of another drug, food, or an external substance alters the pharmacological activity of a drug. This interaction can modify the action of the original drug, affecting its effectiveness and safety.Drug–food interactions are significant as they impact drug absorption, metabolism, and excretion. For example, grapefruit juice is a well-known disruptor of drug metabolism. It inhibits the cytochrome P450 3A4 enzyme, crucial for the metabolism of many...
01:30Drug toxicity: Drug–Drug Interaction
Drug–drug interactions can precipitate toxicity through multiple mechanisms. Absorption interactions alter how drugs enter the body, exemplified when ranitidine increases the absorption of basic drugs, while cholestyramine decreases the levels of propranolol. Protein binding interactions occur when drugs share the same binding sites on plasma proteins. Drugs like aspirin and warfarin, when bound in excess, can lead to increased free drug concentrations, enhancing the potential for...
01:20Antiepileptic Drugs: Modulators of Neurotransmitter Release Mediated by SV2A Protein
Antiepileptic drugs, such as levetiracetam (Keppra) and brivaracetam (Briviact), have emerged as crucial tools in managing epilepsy. These medications exert their therapeutic effects by targeting the synaptic vesicle protein SV2A, a transmembrane glycoprotein primarily found in the brain.
SV2A is a transmembrane glycoprotein located predominantly in the brain, modulating the release of neurotransmitters for neuronal communication. Both levetiracetam and brivaracetam exhibit a high affinity for...
SV2A is a transmembrane glycoprotein located predominantly in the brain, modulating the release of neurotransmitters for neuronal communication. Both levetiracetam and brivaracetam exhibit a high affinity for...
01:18Antiepileptic Drugs: GABAergic Pathway Potentiators
γ-aminobutyric acid or GABA, plays a pivotal role as an inhibitory neurotransmitter in the brain. GABA pathway potentiators, also known as GABAergic drugs, are a class of pharmaceutical agents designed to enhance the functioning of the GABAergic system. These medications primarily treat epilepsy, a neurological disorder characterized by recurrent seizures.
The key GABA pathway potentiators used in epilepsy management are as follows.
Benzodiazepines are a well-known class of drugs used for their...
The key GABA pathway potentiators used in epilepsy management are as follows.
Benzodiazepines are a well-known class of drugs used for their...
01:25Pharmacokinetics: Drug–Drug Interactions
Drug interactions occur when the pharmacological effect of one drug is altered by another substance, either enhancing or diminishing its activity. The drug whose activity is altered is known as the object drug, and the substance causing the alteration is called the agent drug or the precipitant. The net effects of these interactions are mostly undesirable, leading to decreased effectiveness or increased adverse effects. In rare cases, interactions can be beneficial, such as the enhanced...