Case Report Three Patients Needing High Doses of Valproic Acid to Get Therapeutic Concentrations

Copyright © 2015 James Jackson et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Valproic acid (VPA) can autoinduce its own metabolism. Cases requiring VPA doses>4000mg/day to obtain therapeutic plasma concentrations, such as these 3 cases, have never been published. Case 1 received VPA for seizures and schizophrenia and had>50 VPA concentrations in 4 years. A high dose of 5,250mg/day of VPA concentrate was prescribed for years but this dose led to an intoxication when switched to the enterocoated divalproex sodium formulation, requiring a normal dose of 2000mg/day. VPA metabolic capacity was significantly higher