A review of carbamazepine and valproate use in a psychiatric hospital in Thailand

Objective: To review the clinical use of carbamazepine (CBZ) and valproate (VPA) in a psychiatric hospital in Thailand. Design: Retrospective medical record review. Setting: An outpatient department of a psychiatric hospital in the central part of Thailand. Participants: Patients prescribed either CBZ or VPA in January 2005 and continued the medications for at least six months. Results: There were 277 cases receiving either CBZ or VPA during the study period, 57.8% were male. CBZ was prescribed in 92 cases, VPA 185 cases. Mood stabilizing was the most common indication. However, more than 50% were prescribed the medications for other off-license indications. The doses were not slowly titrated. Means of current dose were lower than the recommended doses. A small number of minor adverse drug reactions were found. Weight gain was under recognized. Conclusion: Off-license uses of CBZ and VPA were common. Sub-therapeutic doses were frequently prescribed. The benefits of lower doses in this off-license use need an extensive evaluation. Guidelines for the use of CBZ and VPA in psychiatric patients may be useful for rational drug use program.