From the Guidelines
Before initiating valproate therapy, a baseline assessment including liver function tests, complete blood cell counts, and pregnancy tests is recommended. This assessment is crucial for monitoring potential adverse effects of valproate, such as hepatotoxicity and hematological abnormalities 1. The baseline evaluation should also include measurements of liver enzymes (ALT, AST) and bilirubin, as valproate can cause liver damage, particularly in vulnerable populations.
Key components of the baseline assessment include:
- Liver function tests to monitor for hepatotoxicity
- Complete blood cell counts to detect potential hematological abnormalities
- Pregnancy tests in female patients of childbearing potential, due to the risks associated with valproate use during pregnancy
- Weight measurement, as valproate can cause significant weight gain
- Neurological examination and documentation of seizure frequency and characteristics for patients with epilepsy
Regular monitoring of serum drug levels, hepatic and hematological indices, and patient weight is necessary to ensure safe and effective treatment with valproate 1. Additionally, patients and families should be advised about presenting symptoms of potential adverse effects, as periodic monitoring may not identify all abnormalities. The American Academy of Child and Adolescent Psychiatry recommends regular monitoring of patients on valproate, including liver function tests and complete blood cell counts, every 3-6 months 1.
From the FDA Drug Label
General Because of reports of thrombocytopenia (see ), inhibition of the secondary phase of platelet aggregation, and abnormal coagulation parameters, (e.g., low fibrinogen), platelet counts and coagulation tests are recommended before initiating therapy and at periodic intervals. The baseline assessment needed for valproate includes:
- Platelet counts
- Coagulation tests These assessments are recommended before initiating therapy and at periodic intervals. 2
From the Research
Baseline Assessment for Valproate
To determine the necessary baseline assessment for valproate, it is essential to consider the potential effects of the medication on liver function.
- Liver function tests (LFTs) are crucial in assessing liver injury and hepatic function 3.
- Commonly used LFTs include:
- Alanine transaminase
- Aspartate transaminase
- Alkaline phosphatase
- Bile acid
- Serum bilirubin
- Serum albumin
- Prothrombin time
- In normal pregnancy, changes in LFT values have been observed, including increased serum alkaline phosphatase levels and decreased serum albumin levels due to hemodilution 4.
- Other LFT values, such as aspartate transaminase activity and total bile acid concentrations, do not differ significantly between pregnant and nonpregnant women 4.
- Serum alanine transaminase activity may be slightly higher in the second trimester of pregnancy, although values remain within normal limits 4.