Valproate in Precision Psychiatry

Valproate in Bipolar Disorder

The World Health Organization (WHO) recommends valproate for both acute treatment of bipolar mania and maintenance treatment of bipolar disorder 1
For maintenance treatment, valproate should be continued for at least 2 years after the last episode of bipolar disorder 1
The American Academy of Child and Adolescent Psychiatry suggests that valproate may be used in pediatric bipolar disorder, with treatment algorithms developed to systematically assign patients to mood stabilizers and/or atypical antipsychotics based on clinical presentation 9
For patients with bipolar depression, valproate should be combined with an antidepressant, preferably an SSRI rather than a tricyclic antidepressant 1

Intravenous valproate is recommended as a Level B treatment option (may be administered) for refractory status epilepticus in patients who have failed benzodiazepine treatment 2
Valproate showed 88% efficacy in seizure cessation within 20 minutes, comparable to phenytoin (84%) in a Class II study 3, 4
Valproate controlled seizures within 1 hour in 88% of cases of refractory status epilepticus 5, 6
The Neurocritical Care Society recommends valproate for both emergent treatment of seizures and refractory status epilepticus based on high-level evidence 8, 7
Valproate has a favorable cardiovascular safety profile compared to phenytoin, with studies showing no hypotension in valproate groups versus 12% in phenytoin groups 3, 7

For refractory status epilepticus, intravenous loading doses of 20-30 mg/kg have been studied with infusion rates of 6 mg/kg/hour 3, 5, 7

Valproate may be preferred over phenytoin in patients with cardiovascular comorbidities due to its better hemodynamic profile 2, 7