Dose Adjustment for Subtherapeutic Valproic Acid Level

Important Clinical Considerations

• The American Academy of Child and Adolescent Psychiatry recommends verifying medication adherence, as non-compliance is the most common cause of subtherapeutic levels 1

Monitoring After Dose Adjustment

• The American Academy of Child and Adolescent Psychiatry suggests laboratory monitoring at therapeutic doses should include valproic acid levels every 3-6 months once stable, liver function tests every 3-6 months, and baseline and periodic monitoring for metabolic effects if used long-term 2

Common Pitfalls to Avoid

• The American Academy of Child and Adolescent Psychiatry advises against adding additional antiepileptic drugs before optimizing valproic acid to therapeutic levels, avoiding rapid IV loading unless status epilepticus develops, and not assuming treatment failure without first confirming adequate dosing and compliance 1