Adjunctive Valproic Acid for Delirium and/or Agitation on a Consultation-Liaison Service: A Report of Six Cases

Adjunctive Valproic Acid in Management-Refractory Hyperactive Delirium: A Case Series and Rationale

“…The average time from VPA initiation to delirium resolution was 6.2 days (SD 5 8.0, range 5 1-30). Two patients resolved within 1 day, four resolved within 2 days, two resolved within 3 days, one resolved within 4 days, and four resolved after 9 days or longer (9,11,11, and 30 days). Excluding the outlier of 30 days, the average number of days to delirium resolution was 4.2 days (SD 5 3.8).…”

“…8 Currently, the data on VPA's efficacy in delirium are limited to only two case series comprising a total of eight patients. 9,10 In addition, there are limited data on VPA's usefulness in the management of agitation in patients with dementia, 11 traumatic brain injury (TBI), 12 alcohol withdrawal, and corticosteroidinduced mania. 13 Finally, emerging data support the use of VPA for neuroprotection in acute central nervous system injuries because of its anti-inflammatory, antiapoptotic, and neurotrophic effects.…”

Valproic Acid for Treatment of Hyperactive or Mixed Delirium: Rationale and Literature Review

“…The initial case series detailed the benefits of VPA as adjunct treatment for delirium in 6 patients where other medications (e.g., antipsychotics, benzodiazepines) failed to effectively manage delirium symptoms (50).…”

Delirium: Sifting through the confusion

“…Indeed, there is growing evidence that carbamazepine, oxcarbazepine, and possibly VPA are useful in the treatment of alcohol withdrawal and potentially the delirium associated with it [29]. There have been no defi nitive studies looking at the use of anticonvulsants in the management of delirium, although a small number of case reports have described VPA as a useful adjunct [30]. With our current understanding of the mechanisms of delirium, it would seem clear that cholinesterase inhibitors should play an integral role in the management of this syndrome.…”