Evidence‑Based Management of Valproic Acid–Related Complications

Drug Interactions Affecting Valproic Acid Levels

• Carbapenem antibiotics (e.g., meropenem, imipenem, ertapenem) markedly lower valproic acid concentrations, increasing the risk of breakthrough seizures in patients receiving the drug. 1

Ensuring Accurate Assessment of Toxicity

• Before attributing altered mental status to valproic acid toxicity, clinicians should verify medication adherence to exclude accidental overdose or non‑compliance. 2

Differential Diagnosis of Altered Mental Status in Antiepileptic Therapy

• Both clinical and subclinical seizures can present as altered mental status in individuals treated with antiepileptic medications, necessitating seizure evaluation as part of the work‑up. 3
• Additional potential contributors to altered mental status that must be ruled out include hypoglycemia, hyponatremia, systemic infection, and intracranial pathology. 5