Abstracts

Intravenous valproate sodium (IVVPA; Depacon[reg]) was approved in April, 1997 as an alternate to oral administration temporarily when oral administration is not available. There is limited data on safety and efficacy in adult patients receiving IVVPA in acute seizure situations.
The objective was to review the safety and efficacy of IVVPA in adult patients treated for acute seizures.
A retrospective study was conducted with subjects identified through pharmacy records over the time period of April 2000 through March 2002. Dosages, laboratory studies, vital signs, potential adverse reactions, concommitant medications, infusion rates and seizures and outcome were recorded.
32 patients age 18-89 years were identified. 19 had a history of seizures and on therapy (9 on valproate, 10 other antiseizure medications). 21 patients were in status epilepticus(SE) and the other 11 with acute crescendo seizures.
Patients were infused at rates of 8.33mg/min and 83.33mg/min. Doses ranged from 5.15mg/kg/day to 169.24mg/kg/day. Therapy lasted from 1 to 14 days. A total of 463 doses were given. Target levels were achieved in all cases.
no infusion site complications were reported; nor change in vital signs, nor pain during infusion. No patients developed worsening liver panels. Two patients had thrombocytopenia ([lt]100,000) but were low prior and had alternate explanations (1 bone marrow transplant, 1 post liver/pancreas transplant and septic). One patient developed elevated lipase and clinical signs of pancreatitis following infusion possibly attributable to IVVPA and was discontinued. There were 10 deaths none attribtable to IVVPA (6 anoxia, 2 massive stroke, 2 sepsis).
- 21 patients with SE, 15 had resolution or marked reduction in seizures (3 expired), while 6 did not respond (6 expired). Etiologies for responders were low medication levels 6, anoxia\hypoxic-ischemic 3 (2 expired), tumor 2, breakthrough 1, trauma 1, sepsis 1, stroke 1(expired). Non-responders were anoxia 3, sepsis 2, stroke 1. In the 11 non SE patients, all had seizure resolution. There was one death (anoxia) in patient with low medication level. In the remainig 10, 4 were from low seizure medication levels, 4 from tumors, 1 shunt failure and 1 trauma.
IVVPA was well tolerated during infusion in all patients, including the elderly. Only one complication was felt to be possibly attributable to IVVPA, pancreatitis which resolved with IVVPA cessation. Overall, IVVPA appears safe in acute seizure situations but the practitioner needs to remember possible adverse effects of IVVPA - pancreatitis, elevation of liver function tests, and thrombocytopenia. Our two cases of thrombocytopenia were felt to have other primary causes. IVVPA is highly effective in acute seizure situations with 26/32 cases responding, (15/21 SE cases). Poor response went along with certain etiologies - anoxia, overwhelming sepsis, massive stroke.