The Safety of Rapid Valproic Acid Infusion

Abstract

Summary: Purpose:The recommended rate of administration of valproic acid injection is 20 mg/min. Drug delivery at this rate may be inadequate for expeditious control of seizures. The safety of rapid infusion of valproic acid has not been established, and this study was designed to explore the effects of rapid infusion in patients with acute seizures.Methods: Twenty patients with acute repetitive seizures received 20 mgkg loading doses of valproic acid. Infusion rates ranged from 33.3 to 555 mg/min (median, 200 rng/min). Sixteen patients had received previous or concomitant antiepileptic drugs, with inadequate seizure control. Heart rate, blood pressure, and respiratory rate were measured before infusion and at frequent intervals for 1 hour after infusion. Patients were also observed for changes in level of alertness and signs of local irritation. Results:No patient exhibited a decline in level of consciousness or respiratory function. Two patients with significant contributing factors exhibited declines in blood pressure requiring vasopressors. No significant local irritation was reported. AIthough efficacy was not a measured end point, seizures were abolished in all patients.Conclusions: Infusion of valproic acid at rates between 33 and 555 rng/min is well tolerated. No serious adverse effects attributable to the rapid infusion of valproic acid were encountered, although valproic acid, along with other factors, may have contributed to the hypotension in two patients. Intravenous valproic acid is an option for the control of acute seizures.

Acute Antimanic Efficacy and Safety of Intravenous Valproate Loading Therapy: An Open-Label Study

“…Except local injection site pain, redness [16] and sedation [5], previous studies do not report any other adverse event during intravenous VPA therapy [3,6,13,17,18]. In contrast, 6 of 9 patients of the intravenous group in the present study had experienced at least one adverse event, which was comparatively higher than that in the oral group.…”

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

“…8 Limdi and Faught studied 20 patients with seizure disorder with 20 mg/kg loading doses of IV valproate sodium administered at between 33.3 and 555 mg/min (median 200 mg/min). 9 No patient suffered a change in mental status or respiratory function, and two had significant decrease in blood pressure requiring the administration of vasopressors. 9 Valproic acid has become increasingly popular in the psychiatric literature for treatment of bipolar disorder.…”

“…9 No patient suffered a change in mental status or respiratory function, and two had significant decrease in blood pressure requiring the administration of vasopressors. 9 Valproic acid has become increasingly popular in the psychiatric literature for treatment of bipolar disorder. In addition, it has been used for other aggressive and agitated states due to central nervous system (CNS) trauma, dementia, and other neurodegenerative disorders.…”

Non-convulsive status epilepticus in adults - an overview

“…The use of VPA in patients with intracranial bleedings is questionable because of the various effects of VPA on platelet number and function as well as on several clotting factors [247,248]. But, in general, the safety of i/v VPA, even at high doses, fast infusion rates and in cardiac instable patients, was demonstrated in several studies [249][250][251][252][253][254][255][256][257][258][259]. However, prospective randomised well-(i.e.…”