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Thakur A, Niranjan V, Rastogi P, Razdan R. Acute oedema associated with risperidone use: a report. Gen Psychiatr 2020; 33:e100203. [PMID: 32656495 PMCID: PMC7332176 DOI: 10.1136/gpsych-2020-100203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 05/13/2020] [Accepted: 06/01/2020] [Indexed: 11/17/2022] Open
Abstract
Risperidone acts by potent serotonergic, dopaminergic and alpha adrenergic receptor antagonism. The most common side effects reported are extrapyramidal symptoms, dizziness, sedation, insomnia, headache, anxiety, nausea, constipation and weight gain. Oedema associated with risperidone use is a rare side effect. Here we present a report on pedal oedema associated with use of oral risperidone 4 mg per day for acute-onset psychotic illness. Through this case report we want to make clinicians aware about this important side effect as it can affect patients’ compliance and quality of life.
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Affiliation(s)
- Arpita Thakur
- Department of Psychiatry, Mahatma Gandhi Memorial Medical College, Indore, Madhya Pradesh, India
| | - Vijay Niranjan
- Department of Psychiatry, Mahatma Gandhi Memorial Medical College, Indore, Madhya Pradesh, India
| | - Pali Rastogi
- Department of Psychiatry, MGM Medical College Indore, Indore, Madhya Pradesh, India
| | - Ramghulam Razdan
- Department of Psychiatry, Mahatma Gandhi Memorial Medical College, Indore, Madhya Pradesh, India
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Tunç S, Başbuğ HS. Leg oedema due to low-dose risperidone during maintenance monotherapy of schizophrenia. PSYCHIAT CLIN PSYCH 2017. [DOI: 10.1080/24750573.2017.1379718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Serhat Tunç
- Department of Psychiatry, Faculty of Medicine, Kafkas University, Kars, Turkey
| | - Hamit Serdar Başbuğ
- Department of Cardiovascular Surgery, Faculty of Medicine, Kafkas University, Kars, Turkey
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Cicek E, Cicek IE, Uguz F. Bilateral Pretibial Edema Associated with Paliperidone Palmitate Long-acting Injectable: A Case Report. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2017; 15:184-186. [PMID: 28449568 PMCID: PMC5426490 DOI: 10.9758/cpn.2017.15.2.184] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 05/06/2016] [Accepted: 05/11/2016] [Indexed: 01/22/2023]
Abstract
Peripheral edema is observed as an adverse effect of the usage of antipsychotics in the literature. This case report describes a 36-year-old female patient with the diagnosis of paranoid schizophrenia who presented with pretibial edema following initiation of long-acting injectable paliperidone palmitate. Pretibial edema developed within the second week of treatment and completely disappeared after its discontinuation.
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Affiliation(s)
- Erdinc Cicek
- Department of Psychiatry, Çumra State Hospital, Konya, Turkey
| | - Ismet Esra Cicek
- Department of Psychiatry, Research and Training Hospital, Konya, Turkey
| | - Faruk Uguz
- Department of Psychiatry, Meram Faculty of Medicine, University of Necmettin Erbakan, Konya, Turkey
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Feroz-Nainar C, Selvaraj P, Roy M. Risperidone induced oedema in a child with learning disability and autism. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2016; 10:308-10. [PMID: 16682401 DOI: 10.1177/1362361306063302] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Umar MU, Abdullahi AT. Self-limiting Atypical Antipsychotics-induced Edema: Clinical Cases and Systematic Review. Indian J Psychol Med 2016; 38:182-8. [PMID: 27335511 PMCID: PMC4904752 DOI: 10.4103/0253-7176.183089] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
A number of atypical antipsychotics have been associated with peripheral edema. The exact cause is not known. We report two cases of olanzapine-induced edema and a brief review of atypical antipsychotic-induced edema, possible risk factors, etiology, and clinical features. The recommendation is given on different methods of managing this side effect.
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Affiliation(s)
- Musa Usman Umar
- Department of Psychiatry, Bayero University, Kano, Nigeria; Department of Psychiatry, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Aminu Taura Abdullahi
- Department of Psychiatry, Bayero University, Kano, Nigeria; Department of Psychiatry, Aminu Kano Teaching Hospital, Kano, Nigeria
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Tseng PT, Chen YW, Chung W, Tu KY, Wang HY, Wu CK, Lin PY. Significant Effect of Valproate Augmentation Therapy in Patients With Schizophrenia: A Meta-analysis Study. Medicine (Baltimore) 2016; 95:e2475. [PMID: 26825886 PMCID: PMC5291556 DOI: 10.1097/md.0000000000002475] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Revised: 12/13/2015] [Accepted: 12/16/2015] [Indexed: 11/25/2022] Open
Abstract
Valproate is an anticonvulsant, which is also widely used for treating psychiatric disorders. Some clinical trials have demonstrated benefits of valproate augmentation therapy in schizophrenia. Previous meta-analysis showed inconsistent findings because of limited literature at that time. The aim of this study is to update the newer published data by conducting a meta-analysis of clinical efficacy of valproate augmentation therapy in patients with schizophrenia or schizoaffective disorder. Data sources include electronic research through platform of PubMed. Study eligibility criteria, participants, and interventions were as follows: the inclusion criteria included articles discussing comparisons of the treatment effect in schizophrenic patients treated with antipsychotic augmented with valproate and antipsychotics with/without placebo; articles on clinical trials in humans. The exclusion criteria were case reports or series and nonclinical trials. We compared the effect between antipsychotic treatment with valproate augmentation and antipsychotic monotherapy. Data from clinical trials were pooled by random-effects model, and possible confounding variables were examined through meta-regression and subgroup analysis. Data from 11 articles including 889 patients were included into current meta-analysis. We found patients treated with antipsychotics with valproate augmentation showed significantly more improvement in total psychopathology than those treated with antipsychotics only (P = 0.02). Results from open trials, but not from randomized controlled trials (P = 0.20), showed significant improvement (P = 0.01). In addition, the significance only persisted in the studies conducted with a shorter treatment duration (P < 0.001) rather than longer treatment duration (P = 0.23). There is no difference in the dropout rate between valproate augmentation and antipsychotic treatment only (P = 0.14). We could not perform a detailed meta-analysis for every category of antipsychotics, long-term effect, and safety profiles of valproate augmentation therapy in maintenance treatment, safety in pregnant patients, and subtype of schizophrenia. Our meta-analysis highlights the significantly better treatment effect with valproate augmentation therapy in patients with schizophrenia or schizoaffective disorder, and provides important evidence for supporting the practice of valproate augmentation therapy in these patients.
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Affiliation(s)
- Ping-Tao Tseng
- From the Department of Psychiatry, Tsyr-Huey Mental Hospital, Kaohsiung Jen-Ai's Home, Taiwan (P-TT, WC, K-YT, H-YW, C-KW); Department of Neurology, E-Da Hospital, Kaohsiung, Taiwan (Y-WC); Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan (P-YL); and Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan (P-YL)
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Gabriel L, Darcissac C, Goutelle S, Sève P, Vial T, de La Gastine B. Œdèmes des membres inférieurs au cours d’un traitement par valpromide : cas clinique et revue de la littérature. Rev Med Interne 2015; 36:698-700. [DOI: 10.1016/j.revmed.2014.11.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 09/07/2014] [Accepted: 11/23/2014] [Indexed: 11/27/2022]
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Peripheral Edema Occurring during Treatment with Risperidone Combined with Citalopram. Case Rep Med 2012; 2012:540732. [PMID: 23251178 PMCID: PMC3510775 DOI: 10.1155/2012/540732] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Accepted: 10/03/2012] [Indexed: 11/24/2022] Open
Abstract
An 80-year-old female presented with symptoms of depression, worthlessness, hopelessness, loss of energy, insomnia, impatience, and forgetfulness associated with persecutory delusion that had begun about one year before her visit. She was diagnosed with major depression with psychotic signs and began treatment with risperidone (2 mg/night) and citalopram (20 mg/day). After 20 days, she returned and reported partial improvement in her symptoms, although she had developed severe swelling of the hands and feet. The results of liver and renal function tests and rheumatologic tests were found to be within normal limits. Risperidone was discontinued for a week, and the swelling resolved completely. Risperidone was then administered again, and the swelling returned so that the patient had to discontinue taking the drug. The reappearance of edema on rechallenge is strong evidence implicating risperidone as the cause of the swelling.
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Peripheral edema associated with risperidone oral solution: a case report and a review of the literature. J Clin Psychopharmacol 2012; 32:128-30. [PMID: 22217945 DOI: 10.1097/jcp.0b013e31823f8757] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Risperidone induced periorbital oedema. Ir J Psychol Med 2010; 27:216-217. [PMID: 30199936 DOI: 10.1017/s0790966700001579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Antipsychotic medications are associated with adverse cutaneous reactions (ACRs) in approximately 2-3% of patients. We present three cases of possible risperidone induced periorbital oedema in the absence of any other systemic or local cause responsible for the oedema. The development of periorbital oedema after the initiation of risperidone therapy, and disappearance after the discontinuation of this drug, suggests a possible causal relationship between periorbital oedema and risperidone. To our knowledge, there are very few reports of risperidone therapy and development of periorbital oedema. Risperidone is a valid and effective choice amongst antipsychotic medications, but these cases call for caution regarding ACRs at the time of prescribing.
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Chen CY, Yeh YW, Kuo SC, Shiah IS, Liu PY, Chen CL. Pedal edema associated with addition of low-dose quetiapine to valproate treatment in bipolar disorder. Prog Neuropsychopharmacol Biol Psychiatry 2009; 33:1551-2. [PMID: 19665043 DOI: 10.1016/j.pnpbp.2009.07.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2009] [Revised: 07/15/2009] [Accepted: 07/28/2009] [Indexed: 11/17/2022]
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Abstract
Valproate-related peripheral oedema is usually regarded as a problem occurring after long-term administration of valproate. The scarcity of reports is partially responsible for the lack of a full understanding of this condition. This report describes two patients acquiring peripheral oedema after short-term use of add-on therapy with valproate. The oedema could appear and reappear quickly. Discontinuing valproate resulted in rapid improvement of this condition, and the cause-effect relationship was supported by double challenge. We also put forward a preliminary hypothesis to explain this treatable situation.
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Akdag ST, Fettahoglu EC, Ozatalay E. Pedal edema induced by low-dose risperidone monotheraphy in a child. J Child Adolesc Psychopharmacol 2009; 19:481-2. [PMID: 19702504 DOI: 10.1089/cap.2008.0104] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Senem Turan Akdag
- Department of Child and Adolescent Psychiatry, Akdeniz University Medical Faculty, Antalya, Turkey
| | - E. Cigil Fettahoglu
- Department of Child and Adolescent Psychiatry, Akdeniz University Medical Faculty, Antalya, Turkey
| | - Esin Ozatalay
- Department of Child and Adolescent Psychiatry, Akdeniz University Medical Faculty, Antalya, Turkey
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Abstract
Antipsychotic medications are commonLy associated with adverse cutaneous reactions (ACRs) in approximately 5% of patients. Angio-oedema accompanying urticaria is one of the most serious ACRs. The 36-year-old female patient who was diagnosed with ;Paranoid schizophrenia' 6 years ago, was commenced on ziprasidone 120 mg/day. On day 30 of the treatment, the patient presented urticarial papules and plaques all over the body and angio-oedema in the face. The patient was diagnosed as ;Urticaria + Angio-oedema'. The development of ACRs after the initation of ziprasidone monotherapy, disappearance of lesions after the discontinuation of this antipsychotic, and positive intradermal skin test all suggests a possible causal relationship between ACRs and ziprasidone. To our knowledge, this is the first reported case of urticaria and angio-oedema due to ziprasidone monotherapy. Ziprasidone is a valid and effective choice amongst antipsychotic medications, but this case calls for caution regarding ACRs at the time of prescribing.
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Affiliation(s)
- Cengiz Akkaya
- Uludag University Medical Faculty, Psychiatry Department, Bursa, Turkey.
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Ivanov I, Klein M, Green WH, Coffey B. The challenges of psychopharmacological management of children with severe developmental disabilities. J Child Adolesc Psychopharmacol 2006; 16:793-9. [PMID: 17201623 DOI: 10.1089/cap.2006.16.793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Iliyan Ivanov
- Mount Sinai School of Medicine, New York, New York, USA
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Rozzini L, Ghianda D, Vicini Chilovi B, Padovani A, Trabucchi M. Peripheral oedema related to quetiapine therapy : a case report. Drugs Aging 2005; 22:183-4. [PMID: 15733023 DOI: 10.2165/00002512-200522020-00007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Luca Rozzini
- Geriatric Research Group, Brescia, ItalyDepartment of Neurology, University of Brescia, Brescia, Italy.
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Ravindran A, Silverstone P, Lacroix D, van Schaick E, Vermeulen A, Alexander J. Risperidone Does Not Affect Steady-State Pharmacokinetics of Divalproex Sodium in Patients with Bipolar Disorder. Clin Pharmacokinet 2004; 43:733-40. [PMID: 15301577 DOI: 10.2165/00003088-200443110-00004] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVE Divalproex sodium can interact with many drugs in which combination treatments are used; it can increase plasma concentrations of some drugs by inhibiting metabolism and can increase the free fractions of other medications by displacing them from plasma proteins. The combination of risperidone and divalproex sodium is used to treat the manic phase of bipolar disorder. However, the effect of risperidone on the pharmacokinetics of valproate has not previously been systematically studied. The aims of this study were to determine the effect of repeated doses of oral risperidone on the pharmacokinetics of valproate in subjects stabilised on divalproex sodium and to document the safety of this combination. STUDY DESIGN A multicentre, observational, randomised, parallel group, single-blind, placebo-controlled drug interaction study. PATIENTS Twenty-two patients with bipolar disorder, in remission, were studied. METHODS All subjects were treated with divalproex sodium 1000 mg/day monotherapy on days 1-14. Thereafter, subjects continued to take divalproex sodium for days 15-28; they also received adjunctive treatment with either placebo (n = 11) or risperidone (n = 11) 2mg once daily on days 15 and 16, and 4 mg once daily on days 17-28. Serial blood sampling was performed throughout to determine the plasma concentrations of valproate, risperidone and 9-hydroxy-risperidone. RESULTS On analysis, steady-state pharmacokinetic parameters (peak plasma concentrations [C(max)], time to C(max,) area under the concentration-time curve) of valproate were of the same order of magnitude on day 14 (monotherapy) and day 28 (valproate plus risperidone or placebo), with no period effect. The parameters on day 28 were similar in the risperidone and placebo treatment groups, showing that risperidone, as adjunctive treatment, had no influence on the steady-state pharmacokinetics of valproate. Although there were more adverse events reported in the risperidone group compared with the placebo group (ten vs seven, respectively), none of them were serious or necessitated withdrawal. No clinically relevant changes in laboratory parameters, vital signs or ECG-tracings were observed in either group. CONCLUSION These results indicate that adjunctive risperidone treatment had no influence on the steady-state pharmacokinetics of valproate and this combination was safe and well tolerated.
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Affiliation(s)
- Arun Ravindran
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
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Kores Plesnicar B, Vitorovic S, Zalar B, Tomori M. Three challenges and a rechallenge episode of angio-oedema occurring in treatment with risperidone. Eur Psychiatry 2001; 16:506-7. [PMID: 11777744 DOI: 10.1016/s0924-9338(01)00615-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Hwang JP, Yang CH, Yu HC, Chang JW, Cheng CY, Tsai SJ. The efficacy and safety of risperidone for the treatment of geriatric psychosis. J Clin Psychopharmacol 2001; 21:583-7. [PMID: 11763005 DOI: 10.1097/00004714-200112000-00007] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Risperidone is an atypical antipsychotic drug which has been suggested to be beneficial for the treatment of elderly patients with psychotic symptoms. In this study, we assessed the short-term efficacy and the safety of risperidone in geropsychiatric inpatients with psychotic symptoms. The sample population included 110 elderly inpatients with psychotic disorders. Assessment for drug efficacy using the Brief Psychiatric Rating Scale, Sandoz Clinical Assessment-Geriatric scale, and Clinical Global Impression scale was conducted at baseline and also at 4 weeks subsequent to risperidone treatment commencement. Subsequent to commencing risperidone treatment, 80 patients completed a 4-week therapeutic evaluation. Seventy (87.5%) of the 80 patients experienced mild to substantial improvement using the Clinical Global Impression scale. Adverse effects were monitored in all 110 patients. The most commonly detected adverse effects were weakness of legs or walking problems (43/110; 39.1%) and dizziness (32/110; 29.1%). Peripheral edema was noted in 18 (16.4%) patients. Risperidone, in low doses, appeared to have been effective in this sample of patients older than 65 years with psychotic symptoms. The mean dose (2.1 +/- SD 1.4 mg/day) applied was lower then that suggested for young patients and was related to the each specific patient diagnosis. Peripheral edema and walking problems were commonly observed adverse effects for these elderly patients, such problems having not been seen to the same extent in previous studies of young patients.
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Affiliation(s)
- J P Hwang
- Department of Psychiatry, Veterans General Hospital-Taipei, Taiwan, ROC
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Ravasia S. Risperidone-induced edema. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2001; 46:453-4. [PMID: 11441789 DOI: 10.1177/070674370104600523] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Basel-Vanagaite L, Zeharia A, Amir J, Mimouni M. Edema associated with valproate therapy. Ann Pharmacother 1999; 33:1370-1. [PMID: 10630841 DOI: 10.1345/aph.19070] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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