Buprenorphine and valproic acid / Depakote

Anything about buprenorphine that doesn't fit somewhere above, fit it here!
Post Reply
User avatar
TeeJay
Long Time Member
Long Time Member
Posts: 1146
Joined: Sat Aug 04, 2012 10:02 pm

Buprenorphine and valproic acid / Depakote

Post by TeeJay » Fri Nov 29, 2019 11:41 pm

Has anyone ever been on this combination, or taken these two medications among others?

According to interaction checkers, there is nothing really to be concerned of (aside from sedation, which IMO is negligible).

However I've always found that Suboxone "holds" me a LOT better when I am not taking Depakote. For some reason I am much more likely to get evening / morning cravings while on Depakote, even when my dose of Suboxone is as high as 16mg. And in past treatments, if I have lapsed and used heroin, the Suboxone only marginally curbs the effect of whatever agonist I've used, even on doses as high as 16mg.

What's strange is that after researching whether Depakote alters the liver's rate of metabolism of buprenorphine, it actually says it SLOWS its metabolism if anything. That's really bizarre. When I said this to my GP, he said that liver enzymes vary a lot based on genetics. He even said I could get my DNA tested to work out what enzymes are more prevalent / active in me. However I wanted to run it past you guys first to see if anyone here might know anything. Especially given bipolar and addiction are so commonly co-morbid, and Depakote is quite a common treatment for bipolar disorder.

User avatar
suboxdoc
Site Admin
Site Admin
Posts: 1653
Joined: Sun Feb 24, 2008 9:03 pm
Contact:

Re: Buprenorphine and valproic acid / Depakote

Post by suboxdoc » Mon Dec 02, 2019 11:09 am

I don't know, TeeJay. As you probably saw, valproic acid is listed as a 'weak inhibitor' of CYP3A4, the first metabolic stop for buprenorphine. From my experience with both buprenorphine and methadone, drugs that inhibit or induce that enzyme rarely have a noticeable effect on blood levels.

I'll continue to give it thought, and maybe someone else has ideas?

As an aside, I once wrote a case report of a guy with bipolar who went on a strict protein diet that seemed to trigger a manic episode. My thought was that shifting to a ketogenic diet resulted in greater metabolism of valproic acid: https://www.ncbi.nlm.nih.gov/pubmed/15898971

User avatar
TeeJay
Long Time Member
Long Time Member
Posts: 1146
Joined: Sat Aug 04, 2012 10:02 pm

Re: Buprenorphine and valproic acid / Depakote

Post by TeeJay » Wed Dec 04, 2019 11:43 pm

Interesting you mention that. My sister has mild bipolar / bipolar spectrum. She only required medical treatment during her university years, and since then has managed to stay on top of her symptoms without medication. I wish I could say the same for myself.

That being said, she experimented with a ketogenic diet a couple of years ago as she was fascinated by some of the studies that came through. However after a couple of weeks, and a few days of lost sleep, she gave up because she was frightened by some mood symptoms that were surfacing that reminded her a LOT of the manic symptoms that appeared during her university years. She was fearful that if she kept going, her mental health would suffer. And given she has a high functioning job as an MD, she couldn't afford to come undone.

Post Reply