title: Detrimental effects of divalproex on warfarin therapy following mechanical valve replacement.
abstract: Drug interaction between Warfarin and psychiatric agents may have important therapeutic effects for patients undergoing cardiac surgery. We present a case of a patient in whom concurrent treatment with Warfarin and valproic acid resulted in supratherapeutic international normalized ratio values. A discussion of the possible mechanisms for this interaction as well as a review of interactions between Warfarin and other psychiatric medications is the subject of this case report.
authors.affiliation: Department of Psychiatry, The Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA.
authors.forename: Ashwini
authors.initials: A
authors.lastname: Nadkarni
authors.forename: Mark
authors.initials: M
authors.lastname: Oldham
authors.forename: Mark
authors.initials: M
authors.lastname: Howard
authors.forename: Harold L
authors.initials: HL
authors.lastname: Lazar
authors.forename: Isidore
authors.initials: I
authors.lastname: Berenbaum
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use; D018692:Antimanic Agents / Q000009:adverse effects / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000150:complications / Q000188:drug therapy*; D004347:Drug Interactions; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D006801:Humans; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D011183:Postoperative Complications / Q000139:chemically induced*; D013927:Thrombosis / Q000517:prevention & control; D014635:Valproic Acid / Q000009:adverse effects* / Q000627:therapeutic use; D014859:Warfarin / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D018692:Antimanic Agents; D014859:Warfarin; D014635:Valproic Acid