Valproic Acid

Valproic acid is used as an anticonvulsant agent. When valproic acid is combined with other liver enzyme-inducing anti-epileptic agents; there is a chance of emerging hyperammonemia. Moreover, valproic acid dose correlates with the ammonia level in blood as well. As the dose of valproic acid increases, the ammonia level in blood increases. Hence, caution should be put in place while combining it with other medications and prescribing a suitable dose of valproic acid in order to avoid its potential side effects and its associated risks.1 Severity of the condition and age should also be considered while providing a therapy for seizure. In a given case, the potential risk factor of producing hyperammonemia by valproic acid is the poly drug treatment with topiramate. Based on a case report study, it has been reported that topiramate causes valproic acid induced hyperammonemia in all aged groups.2,3 It has also been observed that valproic acid induced hyperammonemia can occur despite of having normal serum level of valproic …show more content…
Levocarnitine will increase urea production which will help to remove ammonia from the body. The recommended dosage regimen of levocarnitine is 1 gram twice per day.3,5 Consequently, the ammonia level is high in a patient that needs to be excreted out by urine and feces. Hence, as an acute treatment, lactulose can also be given which will help to remove excessive ammonia via defecation. Based on the study, the preferred dosage regimen for the lactulose would be 30 ml by mouth 2 to 4 times a day with the goal of attaining 2 to 4 stools per day. The therapy can be continued until a patient returns to normal. Ammonia level monitoring is also recommended along with the provision of this