Stereoselective monitoring of ± verapamil treatment of women with bipolar disorder

J. M. Perel, K. L. Wisner, G. Rudolph, K. Peindl

Research output: Contribution to journalArticlepeer-review

Abstract

±Verapamil (Ver) appears to be promising for the treatment of bipolar disorder and is safer in pregnancy. We are currently undertaking a comparative, double-blind, random assignment efficacy study of ±Verapamil and Lithium. Target oral dosage (immediate release) of the ±Ver cell ranges from 160-480 mg/d. Here, we report stereoselective pilot data on 19 mid-life female patients. The analyses are with HPLC/fluorescence detection utilizing an Astec chirobiotic V column. The enantiomers of ±Ver and ±NorVer are separated, R:44.1, S:46.7 and I.S. (S-propranolol):31.6, R:67.9 and S:76.5min, respectively; detectability: 2.5-5.ng/ml. Analogously to reported cardiovascular literature, we have found major differences of stereoselective metabolism. The plasma S/R ratio for ±Ver is 0.22±0.03 (S.D.) And ±NorVer is 0.37±0.03 (S.D.). The S-forms for both ±Ver and ±NorVer, also appear to be more active for bipolar symptom amelioration, and are eliminated 2-5 times faster leading to much lower S plasma levels. For optimal therapeutic outcome, plasma level monitoring of the individual enantiomers would appear to be necessary.

Original languageEnglish (US)
Number of pages1
JournalClinical Pharmacology and Therapeutics
Volume65
Issue number2
DOIs
StatePublished - Jan 1 1999

ASJC Scopus subject areas

  • Pharmacology
  • Pharmacology (medical)

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