Valproic Acid
Status epilepticus, Seizure prophylaxis, Broad-spectrum antiepileptic
Indications
- Status epilepticus
- Seizure prophylaxis
- Broad-spectrum antiepileptic
Adult dosing
- status epilepticus: dose: 40; unit: mg/kg; maxDose: 3000; maxDoseAbsolute: true; route: IV over 10 min; weightBased: true
Pediatric dosing
- status epilepticus: dose: 40; unit: mg/kg; maxDose: 3000; maxDoseAbsolute: true; route: IV over 10 min; weightBased: true; pedNote: Use in children >2 years only
Contraindications
- Pregnancy (teratogenic — neural tube defects)
- Hepatic disease or significant hepatic dysfunction
- Urea cycle disorders
- Mitochondrial disease (POLG mutation)
Clinical pearls
- Avoid in pregnancy — high risk of neural tube defects and other teratogenicity
- Avoid in liver disease — fatal hepatotoxicity reported
- Check ammonia level if AMS develops during valproate use — hyperammonemia common
- Drug interactions: increases levels of lamotrigine, phenobarbital
Source and review
- AES Guidelines 2016; Neurocritical Care Society. Last reviewed: 2024-11-01