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Valproic Acid Dosages Necessary to Maintain Therapeutic Concentrations in Children

Summary Steady-state plasma valproic acid (VPA) concentrations were measured in 118 pediatric inpatients taking VPA. There was a significant (p<0.0001) inverse correlation between the daily VPA dosage and the VPA dose ratio (concentration/dose or 1/clearance). The VPA dose ratio was significantly lower in patients taking VPA in combination with phenobarbital (p<0.01), carbamazepine (p<0.05), or multiple other antiepileptic drugs (p<0.0001), compared with those on VPA monotherapy. Neither age nor sex had any influence on VPA dose ratios. No significant (p > 0.1) correlation was found between VPA doses and concentrations in children on monotherapy. The distribution of VPA dose concentrations suggests that children, especially those on VPA polytherapy, require higher than recommended pediatric VPA maintenance doses (>60 mg/kg/day) to maintain concentrations >50 mg/L. Results also indicate that at higher concentrations (>80 mg/L), increasing doses may produce less than proportional increases in total VPA concentration.