Valproic acid prescriptions are rising without evidence

Prescriptions for bipolar disorders in elderly patients have shifted away from lithium and towards valproic acid (divalproex in North America), but no evidence of the benefit of valproic acid exists. In a large population study using linked prescription, hospitalisation, and physician claims databases, Shulman and colleagues (p 960) examined prescribing patterns in 9243 patients aged 65 and older in Ontario, Canada, who had no history of convulsive disorders. Over an eight year period, the number of new lithium users fell from 653 to 281, whereas the number of new valproic acid users rose from 183 to 1090, a trend that persisted when patients with a diagnosis of dementia were eliminated. Although elderly patients often do not tolerate lithium, evidence on the benefit and tolerability of valproic acid must be sought, say the authors, before it is substituted in the treatment of bipolar disorders.

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Relevant Article

Changing prescription patterns for lithium and valproic acid in old age: shifting practice without evidence

Kenneth I Shulman, Paula Rochon, Kathy Sykora, Geoffrey Anderson, Muhammad Mamdani, Susan Bronskill, and Chau T T Tran
BMJ 2003 326: 960-961. [Extract] [Full Text] [PDF]