What are the effects of taking 300 pills of sodium valproate? - case report
DOI:
https://doi.org/10.12775/JEHS.2022.12.08.063Keywords
drug overdose, sodium valproate, sodium valproate overdose, sodium valproate poisoning, suicideAbstract
INTRODUCTION: Sodium valproate is one of the most important antiepileptic drugs. It can be effective as a preventive treatment for migraine, it has also found use in the maintenance treatment of bipolar disorder and acute mania,it is sometimes used in the treatment of chronic neuropathic pain and fibromyalgia, in the treatment of schizophrenia borderline personality disorder and acquired brain injury, this drug is used off-label. Its overdose can be fatal.
MATERIALS AND METHOD: Patient information was collected from hospital records available in the clinical toxicology department. In addition, we conducted a literature review on sodium valproate treatment, its toxicity, side effects and pharmacokinetics using PubMed.
CASE REPORT: A 57-year-old patient with a history of depressive disorders was admitted to the Clinical Department of Toxicology and Cardiology in Lublin for intentional intoxication with the drug Absenor (sodium valproate). The patient had taken 3 packages of Absenor 500 mg (300 tablets in total) for suicidal purposes. The determined concentration of valproic acid was 841 µg/ml, and the patient's condition was very severe. Despite the treatment administered-multiple attempts at gastric lavage, administration of activated charcoal, performance of hemodialysis procedures, administration of infusion of catecholamines, the patient died on the fifth day of hospitalization.
CONCLUSION: An overdose of sodium valproate can be fatal. Keep this in mind when ordering this drug for patients with a positive history of suicide attempts.
References
Balagura G, Iapadre G, Verrotti A, Striano P. Moving beyond sodium valproate: choosing the right anti-epileptic drug in children. Expert Opin Pharmacother. 2019 Aug;20(12):1449-1456. doi: 10.1080/14656566.2019.1617850. Epub 2019 May 17. PMID: 31099271.
Duncan S. Teratogenesis of sodium valproate. Curr Opin Neurol. 2007 Apr;20(2):175-80. doi: 10.1097/WCO.0b013e32805866fb. PMID: 17351488.
Huang W, Ren X, Shen F, Xing B. Sodium valproate induced acute pancreatitis in a bipolar disorder patient: a case report. BMC Pharmacol Toxicol. 2019 Nov 29;20(1):71. doi: 10.1186/s40360-019-0373-z. PMID: 31783774; PMCID: PMC6884746.
Alsdorf R, Wyszynski DF. Teratogenicity of sodium valproate. Expert Opin Drug Saf. 2005 Mar;4(2):345-53. doi: 10.1517/14740338.4.2.345. PMID: 15794725.
Amanat M, Togha M, Agah E, Ramezani M, Tavasoli AR, Azizi Malamiri R, Fashandaky F, Heidari M, Salehi M, Eshaghi H, Ashrafi MR. Cinnarizine and sodium valproate as the preventive agents of pediatric migraine: A randomized double-blind placebo-controlled trial. Cephalalgia. 2020 Jun;40(7):665-674. doi: 10.1177/0333102419888485. Epub 2019 Nov 10. PMID: 31707814.
Dakhale GN, Sharma VS, Thakre MN, Kalikar M. Low-dose sodium valproate versus low-dose propranolol in prophylaxis of common migraine headache: A randomized, prospective, parallel, open-label study. Indian J Pharmacol. 2019 Jul-Aug;51(4):255-262. doi: 10.4103/ijp.IJP_457_18. PMID: 31571712; PMCID: PMC6759533.
Khani S, Hejazi SA, Yaghoubi M, Sharifipour E. Comparative study of magnesium, sodium valproate, and concurrent magnesium-sodium valproate therapy in the prevention of migraine headaches: a randomized controlled double-blind trial. J Headache Pain. 2021 Apr 7;22(1):21. doi: 10.1186/s10194-021-01234-6. PMID: 33827421; PMCID: PMC8028183.
Haddad PM, Das A, Ashfaq M, Wieck A. A review of valproate in psychiatric practice. Expert Opin Drug Metab Toxicol. 2009 May;5(5):539-51. doi: 10.1517/17425250902911455. PMID: 19409030.
Gill D, Derry S, Wiffen PJ, Moore RA. Valproic acid and sodium valproate for neuropathic pain and fibromyalgia in adults. Cochrane Database Syst Rev. 2011 Oct 5;2011(10):CD009183. doi: 10.1002/14651858.CD009183.pub2. PMID: 21975791; PMCID: PMC6540387.
Ala M, Mohammad Jafari R, Nematian H, Ganjedanesh MR, Dehpour AR. Sodium Valproate Improves Skin Flap Survival via Gamma-Aminobutyric Acid and Histone Deacetylase Inhibitory System. J Surg Res. 2020 Feb;246:519-526. doi: 10.1016/j.jss.2019.09.036. Epub 2019 Oct 17. PMID: 31630884.
Tekin M, Kaya-Yertutanol FD, Çevreli B, Özdoğru AA, Kulaksız H, Uzbay İT. Sodium valproate improves sensorimotor gating deficit induced by sleep deprivation at low doses. Turk J Med Sci. 2021 Jun 28;51(3):1521-1530. doi: 10.3906/sag-2011-229. PMID: 33517611; PMCID: PMC8283464.
Camilleri L. Lesson of the month 1: Sodium valproate-induced encephalopathy. Clin Med (Lond). 2018 Oct;18(5):430-432. doi: 10.7861/clinmedicine.18-5-430. PMID: 30287443; PMCID: PMC6334110.
Macfarlane A, Greenhalgh T. Sodium valproate in pregnancy: what are the risks and should we use a shared decision-making approach? BMC Pregnancy Childbirth. 2018 Jun 1;18(1):200. doi: 10.1186/s12884-018-1842-x. PMID: 29859057; PMCID: PMC5984824.
Yang CS, Zhang LL, Lin YZ, Guo Q. Sodium valproate for the treatment of Tourette׳s syndrome in children: a systematic review and meta-analysis. Psychiatry Res. 2015 Apr 30;226(2-3):411-7. doi: 10.1016/j.psychres.2014.08.058. Epub 2014 Oct 2. PMID: 25724485.
Brigo F, Igwe SC. Ethosuximide, sodium valproate or lamotrigine for absence seizures in children and adolescents. Cochrane Database Syst Rev. 2017 Feb 14;2(2):CD003032. doi: 10.1002/14651858.CD003032.pub3. Update in: Cochrane Database Syst Rev. 2019 Feb 08;2:CD003032. PMID: 28195639; PMCID: PMC6464603.
Oztopuz O, Turkon H, Buyuk B, Coskun O, Sehitoglu MH, Ovali MA, Uzun M. Melatonin ameliorates sodium valproate-induced hepatotoxicity in rats. Mol Biol Rep. 2020 Jan;47(1):317-325. doi: 10.1007/s11033-019-05134-6. Epub 2019 Oct 17. PMID: 31624995.
Janković SM, Janković SV. Lessons learned from the discovery of sodium valproate and what has this meant to future drug discovery efforts? Expert Opin Drug Discov. 2020 Nov;15(11):1355-1364. doi: 10.1080/17460441.2020.1795125. Epub 2020 Jul 20. PMID: 32686964.
Lebedevs T, Gan M, Teoh SWK, Brown P. Analysis of Perinatal Women Attending a Mother and Baby Unit Taking Sodium Valproate or Lithium with a Diagnosis of Bipolar Affective Disorder. Psychiatr Q. 2020 Sep;91(3):695-701. doi: 10.1007/s11126-020-09729-2. PMID: 32157548.
https://rejestrymedyczne.ezdrowie.gov.pl/api/rpl/medicinal-products/16807/characteristic stan na 3.08.2022
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2022 Kinga Pożarowska, Kinga Brzuszkiewicz , Gracjan Rudziński, Michał Tchórz
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
The periodical offers access to content in the Open Access system under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0
Stats
Number of views and downloads: 763
Number of citations: 0