Valproic Acid Complications

Use of valproic acid during pregnancy is associated with a 1–2% risk of neural tube defect (NTD) 1).

Valproic acid (VPA) is a commonly used drug for epilepsy, psychiatric disorders and migraine and is frequently used in neurosurgical intensive care units. Though most of its side-effects are mild and transient, certain idiosyncratic side-effects have been attributed to VPA. Valproate induced hyperammonemia (VIH) is one such side-effect 2)

Valproate encephalopathy 3).

Interstitial pneumonitis 4).


A considerable number of patients using VPA were diagnosed with coagulopathy, especially platelet function disorder. Further prospective studies are needed to confirm the need for comprehensive laboratory testing before elective high-risk surgery in these patients 5).


1)
Oakeshott P, Hunt GM. Valproate and Spina Bifida. Br Med J. 1989; 298:1300–1301
2)
Kumar A, Suri A, Sharma BS. Severe valproate induced hyperammonemic encephalopathy successfully managed with peritoneal dialysis. Indian J Crit Care Med. 2014 Jul;18(7):461-3. doi: 10.4103/0972-5229.136076. PubMed PMID: 25097360; PubMed Central PMCID: PMC4118513.
3)
Zhu D, Su Z, Ye S, Chen X, Zhuge G, Wu Z. [Clinical misdiagnosis analysis of valproate encephalopathy]. Zhonghua Yi Xue Za Zhi. 2014 Sep 9;94(33):2610-2. Chinese. PubMed PMID: 25511495.
4)
Kim SJ, Jhun BW, Lee JE, Kim K, Choi HY. A case of drug-induced interstitial pneumonitis caused by valproic Acid for the treatment of seizure disorders. Tuberc Respir Dis (Seoul). 2014 Sep;77(3):145-8. doi: 10.4046/trd.2014.77.3.145. Epub 2014 Sep 30. PubMed PMID: 25309611; PubMed Central PMCID: PMC4192314.
5)
Post DS, van der Veer A, Schijns OEMG, Klinkenberg S, Rijkers K, Wagner GL, van Kranen-Mastenbroek VHJM, Willems PCPH, Verhezen PWM, Beckers EAM, Heubel-Moenen FCJI, Henskens YMC. Assessment of need for hemostatic evaluation in patients taking valproic acid: A retrospective cross-sectional study. PLoS One. 2022 Feb 25;17(2):e0264351. doi: 10.1371/journal.pone.0264351. PMID: 35213601.
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