Uz Yasemin, Hariri Aytül, Ünübol Hüseyin, Bilici Mustafa
Erenkoy Education and Training Hospital, Psychiatry Department, Istanbul, Turkey.
Turk Psikiyatri Derg. 2012 Winter;23(4):281-3.
Valproate (VPA) and lorazepam are excreted mainly by glucuronide conjugation. VPA reduces the excretion of lorazepam as a result of the administration of these two medications together. As a result of these interactions, even if rarely, serious adverse effects such as coma may develop. Herein, we present two cases of stupor which developed after the addition of lorazepam to treatment administered with VPA. The first patient was being followed for five years with a diagnosis of schizoaffective disorder. She was subjected to a treatment of VPA at 1000 mg/day and an antipsychotic drug. On the twentieth day of the treatment, Lorazepam 2.5 mg was administered as an anxiolytic. The second patient was being followed with a diagnosis of schizophrenia for nine years. A VPA treatment of 750 mg/day was initiated together with an antipsychotic treatment. On the eighth day of the treatment, Lorazepam 2.5 mg was administered. A few hours later, a stupor manifestation developed in both of the patients. Administration of the entire medication to the patients was terminated and parenteral liquid administration was initiated. The clinical profile was back to normal approximately 24-36 hours following the termination of the medication. Studies about the clinical reflections of the VPA and Lorazepam interaction are limited. However, it must be remembered that as a result of the interaction of these two medications, conditions that vary between stupor and coma may arise.
丙戊酸盐（VPA）和劳拉西泮主要通过葡萄糖醛酸结合作用排泄。由于同时服用这两种药物，VPA会减少劳拉西泮的排泄。由于这些相互作用，即使很少见，也可能会出现诸如昏迷等严重不良反应。在此，我们报告两例在VPA治疗中加用劳拉西泮后出现木僵的病例。首例患者因精神分裂症伴情感障碍被随访5年。她接受了每日1000毫克VPA及一种抗精神病药物的治疗。在治疗的第20天，给予2.5毫克劳拉西泮作为抗焦虑药。第二例患者因精神分裂症被随访9年。开始每日750毫克VPA治疗并联合抗精神病治疗。在治疗的第8天，给予2.5毫克劳拉西泮。数小时后，两名患者均出现木僵表现。停止给患者服用所有药物并开始静脉补液。停药后约24 - 36小时临床症状恢复正常。关于VPA与劳拉西泮相互作用的临床反映的研究有限。然而，必须记住，由于这两种药物的相互作用，可能会出现从木僵到昏迷不等的情况。
