In a double-blind, randomized and placebo-controlled trial, adjuvant allopurinol
improved symptoms of mania in in-patients suffering from bipolar disorder.
Author(s): Jahangard L(1), Soroush S(1), Haghighi M(1), Ghaleiha A(1), Bajoghli H(2),
Holsboer-Trachsler E(3), Brand S(4).
Affiliation(s): Author information:
(1)Research Center for Behavioral Disorders and Substances Abuse; Hamadan
University of Medical Sciences, Hamadan, Iran. (2)Psychiatry & Psychology
Research Center (PPRC), Roozbeh Hospital, Tehran University of Medical Sciences,
Tehran, Iran; ASEAN Institute for Health Development, Mahidol University, Salaya,
Thailand. (3)Psychiatric Clinics of the University of Basel, Center for
Affective, Stress and Sleep Disorders (ZASS), Basel, Switzerland. (4)Psychiatric
Clinics of the University of Basel, Center for Affective, Stress and Sleep
Disorders (ZASS), Basel, Switzerland; Department of Sport, Exercise and Health,
Division of Sport Science, University of Basel, Basel, Switzerland. Electronic
address: Serge.brand@upkbs.ch.
Publication date & source: 2014, Eur Neuropsychopharmacol. , 24(8):1210-21
Allopurinol is a drug used primarily to treat hyperuricemia. In patients
suffering from acute mania, increased levels of uric acid are observed, and
symptom improvements are associated with decreased levels of uric acid.
Accordingly, a purinergic dysfunction is plausibly a causative factor in the
pathophysiology of mania. The aim of the present study was therefore to
investigating whether allopurinol has benefits for patients treated with sodium
valproate during acute mania. (Background) A double-blind, placebo-controlled
study lasting 4 weeks was performed. The intention-to-treatment population
included 57 patients; 50 concluded the study per protocol. Patients suffering
from BPD and during acute mania were randomly assigned either to a treatment
(sodium valproate 15-20 mg/kg+300 mg allopurinol twice a day) or to a control
condition (sodium valproate 15-20 mg/kg+placebo). Experts rated illness severity
and illness improvements (Clinical Global impression), and extent of mania via
the Young Mania Rating scale. Uric acid levels were assessed at the beginning and
end of the study. (Experimental procedures) Compared to the control group,
symptoms of mania decreased significantly over time in the treatment group. Uric
acid levels declined significantly in the treatment as compared to the control
group. Probability of remission after 4 weeks was 23 times higher in the
treatment than the control group. Lower uric acid levels after 4 weeks were
associated with symptom improvements. (Results) The pattern of results from this
double-blind, randomized and placebo-controlled study indicates that adjuvant
allopurinol leads to significant improvements in patients suffering from acute
mania (Conclusion).
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