A multicenter. open-label study of the safety of intravenous sodium valproate in 318 hospitalized patients with epilepsy is reported from the NYU Hospital for Joint Diseases; MINCEP Epilepsy Care and Minnesota Epilepsy Group, MN; University of Texas, Houston; Medical College of Virginia, Richmond; Bowman-Gray School of Medicine, Winston-Salem, NC; and University of Miami, FL. Mean age was 34 years (range, 2-87 years). Valproate aqueous solution (500mg/5 ml), one-fourth daily dose (median dose 375 mg or 5.1 mg/kg), diluted with 50 ml normal saline or 5% dextrose/water, infused over 1 hour, repeated 6 hourly for up to 2 days. Transient severe side effects in 54 (17%) included headache, reaction at injection site, nausea, vomiting, somnolence (2% each), dizziness, and abnormal taste (1% each). Six left the study prematurely due to valproate intolerance: pain at IV site, amylase elevations, headache, nausea and vomiting. Abnormal serum chemistries following treatment in 7 generally returned to normal. [1]

COMMENT. This study demonstrates the relative safety of IV valproate, which is not yet available for general use in the US. Previous studies in Europe, where the IV preparation is available, have demonstrated efficacy in neonatal seizures, and in neurosurgical adult patients with status epilepticus resistant to diazepam. The authors recommend further trials to determine optimal dose, efficacy, and safety.