From the FDA Drug Label
Inflammation of your pancreas that can cause death. Call your healthcare provider right away if you have any of these symptoms: •severe stomach pain that you may also feel in your back •nausea or vomiting that does not go away Valproate (PO) can cause pancreatitis.
- Symptoms of pancreatitis include:
- Severe stomach pain that may also be felt in the back
- Nausea or vomiting that does not go away 1
From the Research
Valproic acid is the most commonly associated antiepileptic drug (AED) with pancreatitis, and it is recommended to discontinue its use if symptoms of pancreatitis occur, based on the most recent and highest quality study available 2.
Key Points
- Valproic acid-induced pancreatitis can occur at any time during treatment, with a high fatality rate of 16% 2.
- The risk of pancreatitis appears to be higher in children, those with polytherapy, and patients with certain metabolic disorders 3.
- Symptoms of drug-induced pancreatitis include abdominal pain, nausea, vomiting, and elevated pancreatic enzymes 4.
- Alternative AEDs with lower pancreatitis risk include levetiracetam, topiramate, and gabapentin, though any medication can potentially cause adverse reactions in susceptible individuals 5.
Mechanism and Risk Factors
- The mechanism behind AED-induced pancreatitis is not fully understood but may involve direct toxic effects on pancreatic cells, immunologic reactions, or metabolic disturbances 6.
- Rechallenge with valproic acid after recovery from pancreatitis is not recommended, as it can lead to a further episode of pancreatitis in 84% of cases 2.
Clinical Implications
- Prompt medical evaluation is necessary if a patient on valproic acid or other AEDs develops symptoms of pancreatitis, and the offending medication should typically be discontinued 2.
- Clinicians should be aware of the risk of pancreatitis associated with valproic acid and monitor patients closely for symptoms, especially during the first year of treatment 3.