The Tolerability of Oral-Loaded Valproate After Remission of Acute Mania in Japanese Patients With Bipolar Disorder

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Sir: A patient presented to us having experienced a fewdays of massive epistaxis and hyposphagma (severe hemorrhageinto the conjunctiva) while taking paroxetine. Pharmaceuticaluse was also notable for the peripheral vasodilatorlimaprost alfadex. To our knowledge, no such case has been reportedin the literature.