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Uso de Medicamentos a Demanda para la Agitación en Formulaciones de Ácido Valproico
Michael Ley1,2, Casey Tiefenthaler1, Jamie Kneebusch3
1Department of Pharmacy, UC San Diego Health, San Diego, California.
Current therapeutic research, clinical and experimental
|February 25, 2026
Resumen
La formulación del ácido valproico (VPA) impacta el control de los síntomas para el trastorno bipolar I y el trastorno esquizoafectivo. El VPA de liberación prolongada puede reducir la necesidad de dosis a demanda de benzodiazepinas y antipsicóticos para la agitación.
Área de la Ciencia:
- Psiquiatría
- Farmacología
- Terapéutica Clínica
Sus antecedentes:
- Existen variaciones farmacocinéticas entre las formulaciones de liberación inmediata (IR), liberación retardada (DR) y liberación prolongada (ER) de ácido valproico (VPA).
- Estas diferencias farmacocinéticas pueden influir en la eficacia del tratamiento y en los resultados del paciente.
- Los medicamentos a demanda (pro re nata, PRN) pueden servir como indicadores de la efectividad de la medicación programada para el manejo de la agitación.
Objetivo del estudio:
- Comparar el número de dosis a demanda de benzodiazepinas y antipsicóticos administradas para la agitación en diferentes formulaciones de VPA (IR, DR, ER).
- Investigar la asociación entre la formulación de VPA y la necesidad de medicamentos a demanda en pacientes con trastorno bipolar I o trastorno esquizoafectivo.
Principales métodos:
- Revisión retrospectiva de 150 pacientes con trastorno bipolar I o trastorno esquizoafectivo que recibieron terapia de mantenimiento con VPA.
- Resultado primario: dosis diarias promedio de benzodiazepinas y/o antipsicóticos a demanda para la agitación.
- Resultado secundario: dosis diaria total (DDT) de VPA. Los análisis estadísticos incluyeron ANOVA y regresión múltiple jerárquica.
Principales resultados:
- La formulación de VPA se asoció significativamente con las dosis diarias promedio de antipsicóticos y/o benzodiazepinas a demanda, incluidos los antipsicóticos solos.
- Estas asociaciones se mantuvieron significativas después de ajustar por factores de confusión como la edad, el sexo, la raza y la dosis diaria total (DDT) de VPA.
Conclusiones:
- La formulación de VPA influye significativamente en el requisito de medicamentos a demanda para controlar la agitación.
- Estos hallazgos sugieren diferencias dependientes de la formulación en el control de los síntomas, lo que justifica una mayor investigación sobre la administración óptima de VPA para afecciones psiquiátricas.
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