Despite its utility, VPA is associated with several common side effects, including tremors, weight gain, alopecia, liver dysfunction, gastrointestinal disturbances
Divalproex sodium is used to treat certain types of seizures (epilepsy)
Chronic Toxicity
Acute phenytoin toxicity may cause ataxia, nystagmus, and other cerebellar signs which usually disappear when the dose is lowered or the drug is discontinued
Fine hand tremor may occur during initial therapy for the acute manic phase, and may persist during therapy
Can be asymptomatic or cause Valproate associated Hepatic Encephalopathy (VPE)
mental depression with restlessness and nervousness or other mood or mental changes
unusual bleeding or bruising
Lithium, a monovalent cation similar to sodium with an unknown mechanism, was first approved by the U
Toxic Metabolites of Valproic Acid
Depakote can cause liver failure that may be fatal, especially in children under age 2 and in people with liver problems caused by certain genetic disorders
Serum levels of lithium above 2
From a neurologic perspective, opioids can cause euphoria, agitation, drowsiness, delirium, and miotic (“pinpoint”) pupils
There have also been reports of crack cocaine being adultered with phenytoin, which can lead to an
loss of consciousness
Sodium valproate or valproic acid is becoming an increasingly common agent to be taken in overdose, with a sharp rise in incidence over the last 5 years [1, 2]