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October 1984, Vol 138, No. 10 >
Article | October 1984

On the Toxicity of Valproic Acid FREE

Am J Dis Child. 1984;138(10):901-903. doi:10.1001/archpedi.1984.02140480003001.
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The article by Wyllie et al1 in this issue of the AJDC illustrates the therapeutic dichotomy presented by valproic acid or its sodium salt. Valproic acid, as a single agent or in combination with other anticonvulsant drugs, has proved to be uniquely effective in the treatment of a number of patients with otherwise refractory seizures. Conversely, valproic acid has been responsible for grave disease or death in some patients when used by itself or with other anticonvulsant drugs. Most fatalities have been associated with hepatic failure,2 some with pancreatitis,1 and in some the cause of death was indeterminate because of inadequate premortem or postmortem data.

The case reports presented by Wyllie et al1 illustrate the rapidity with which pancreatitis can develop, its serious nature, the difficulty of diagnosis, and the exacting demands of its treatment. The authors are to be commended for

REFERENCES

1 +
Wyllie E, Wyllie R, Cruse RP, et al:  Pancreatitis associated with valproic acid therapy . AJDC 1984;;138:912-914.
2 +
Dreifuss FE:  Treatment of the nonconvulsive epilepsies . Epilepsia 1983;;24( (suppl 1) ):545-554.
3 +
Callaghan N, O'Hare J, O'Driscoll D, et al:  Comparative study of ethosuximide and sodium valproate in the treatment of typical absence seizures (petit mal) . Dev Med Child Neurol 1982;; 24:830-836.
4 +
Williams LHP, Reynolds RP, Emery JL:  Pancreatitis during sodium valproate treatment . Arch Dis Child 1983;;58:543-544.
5 +
Allen RJ, Coulter DL:  Valproic acid-induced pancreatitis in children . Pediatrics 1980;; 65:1194-1195.
6 +
Bale JF, Gay PE, Madsen JA:  Monitoring of serum amylase levels during valproic acid therapy . Ann Neurol 1982;;11:217-218.
7 +
 Valproic acid approved . Ann Neurol 1978;;3: 35.
8 +
Physicians' Desk Reference , ed 33. Oradell, NJ, Medical Economics Books, 1979;, p 513.
9 +
Physicians' Desk Reference , ed 38. Oradell, NJ, Medical Economics Books, 1984;, p 510.
10 +
Turnbull DM:  Adverse effects of valproate . Adv Drug React Acute Poison Rev 1983;;2:191-216.
11 +
Sugimoto T, Nishida N, Yasuhara A, et al:  Reye-like syndrome associated with valproic acid . Brain Dev 1983;;5:334-337.
12 +
Keene DL, Humphreys P, Carpenter B, et al:  Valproic acid producing a Reye-like syndrome . Can J Neurol Sci 1982;;9:435-437.
13 +
Committee on Drugs:  Valproic acid: Benefits and risks . Pediatrics 1982;;70:316-319.
14 +
Isom JB, Gerber N, Lynn RK, et al:  Pharmacokinetic studies of valproic acid: Serum half-life and tissue distribution in two children dying in acute hepatic failure , abstracted. Ann Neurol 1979;;6:178.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

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References

1 +
Wyllie E, Wyllie R, Cruse RP, et al:  Pancreatitis associated with valproic acid therapy . AJDC 1984;;138:912-914.
2 +
Dreifuss FE:  Treatment of the nonconvulsive epilepsies . Epilepsia 1983;;24( (suppl 1) ):545-554.
3 +
Callaghan N, O'Hare J, O'Driscoll D, et al:  Comparative study of ethosuximide and sodium valproate in the treatment of typical absence seizures (petit mal) . Dev Med Child Neurol 1982;; 24:830-836.
4 +
Williams LHP, Reynolds RP, Emery JL:  Pancreatitis during sodium valproate treatment . Arch Dis Child 1983;;58:543-544.
5 +
Allen RJ, Coulter DL:  Valproic acid-induced pancreatitis in children . Pediatrics 1980;; 65:1194-1195.
6 +
Bale JF, Gay PE, Madsen JA:  Monitoring of serum amylase levels during valproic acid therapy . Ann Neurol 1982;;11:217-218.
7 +
 Valproic acid approved . Ann Neurol 1978;;3: 35.
8 +
Physicians' Desk Reference , ed 33. Oradell, NJ, Medical Economics Books, 1979;, p 513.
9 +
Physicians' Desk Reference , ed 38. Oradell, NJ, Medical Economics Books, 1984;, p 510.
10 +
Turnbull DM:  Adverse effects of valproate . Adv Drug React Acute Poison Rev 1983;;2:191-216.
11 +
Sugimoto T, Nishida N, Yasuhara A, et al:  Reye-like syndrome associated with valproic acid . Brain Dev 1983;;5:334-337.
12 +
Keene DL, Humphreys P, Carpenter B, et al:  Valproic acid producing a Reye-like syndrome . Can J Neurol Sci 1982;;9:435-437.
13 +
Committee on Drugs:  Valproic acid: Benefits and risks . Pediatrics 1982;;70:316-319.
14 +
Isom JB, Gerber N, Lynn RK, et al:  Pharmacokinetic studies of valproic acid: Serum half-life and tissue distribution in two children dying in acute hepatic failure , abstracted. Ann Neurol 1979;;6:178.

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