Valproic Acid and Diaphoresis
Valproic acid can cause diaphoresis (excessive sweating) as an adverse effect, though it is not among the most commonly reported side effects of this medication.
Adverse Effects of Valproic Acid
Valproic acid is a widely-used antiepileptic drug prescribed for epilepsy and psychiatric disorders. While it has a relatively favorable safety profile, it is associated with several adverse effects:
Common Adverse Effects
- Weight gain (often within first 3 months of therapy, with women being more susceptible) 1
- Hepatotoxicity
- Thrombocytopenia 2
- Hyperammonemic encephalopathy
- Neurological toxicity
Less Common Adverse Effects
- Diaphoresis (excessive sweating)
- Hypersensitivity reactions
- Metabolic and endocrine adverse events
Mechanism of Diaphoresis with Valproic Acid
The exact mechanism by which valproic acid causes diaphoresis is not well-established in the available evidence. However, it may be related to:
- Central nervous system effects on thermoregulation
- Metabolic changes induced by the medication
- Autonomic nervous system alterations
Clinical Considerations
Monitoring for Adverse Effects
When prescribing valproic acid, clinicians should monitor for:
- Liver enzyme levels 3
- Platelet counts 3
- Prothrombin time and partial thromboplastin time 3
- Weight changes (baseline and regular follow-up) 1
- Signs of hyperammonemia
Management of Diaphoresis
If a patient develops significant diaphoresis while on valproic acid:
- Evaluate for other potential causes of excessive sweating
- Consider dose adjustment if appropriate
- Consider switching to an alternative antiepileptic medication if diaphoresis is severe or bothersome
Alternative Medications
If diaphoresis is problematic, consider alternatives such as:
- Levetiracetam (has become the drug of first choice at most neuro-oncology centers) 4
- Lamotrigine (good antiseizure activity but requires several weeks to reach sufficient drug levels) 4
- Lacosamide (potential add-on treatment for inadequate seizure control with monotherapy) 4
Special Considerations
Avoid in Certain Populations
- Valproic acid must not be used in females who may become pregnant 4
- Use with caution in patients with liver disease
- Monitor closely in patients on chemotherapy (may be associated with higher hematologic toxicities) 4
Drug Interactions
- Check for interactions with other medications regularly 4
- Avoid concurrent use with enzyme-inducing antiepileptic drugs when possible
- Potential interactions with steroids and various cytotoxic and targeted agents 4
Conclusion
While diaphoresis is not among the most commonly reported adverse effects of valproic acid in the available evidence, it can occur. When managing patients on valproic acid who experience excessive sweating, clinicians should evaluate for other potential causes, consider dose adjustments, and potentially switch to alternative medications if the symptom is severe or significantly impacts quality of life.