Valproic Acid in Dementia
Journal of Pharmacy Practice,  Clinical Article

Dolder CR et al. – Valproic acid appears to have limited efficacy as monotherapy in many patients with dementia. Its optimal role may be in combination with other psychotropics as a treatment of agitation associated with dementia.

  • Valproic acid is widely used in the treatment of behavioral disturbances in patients with dementia; however, there is uncertainty about its dosing and studies have reported mixed findings.
  • The current article examines published trials of valproic acid in the treatment of patients with dementia to identify whether an optimal dosing strategy exists.
  • Secondarily, valproic acid dosing from published studies is compared with a real-world 5-year sample of valproic acid prescribing.
  • Twenty studies met selection criteria and were included in the review.
  • Based primarily on uncontrolled trials and the current retrospective study, valproic acid serum levels between 40 and 60 mcg/mL and relatively low doses (ie, 7-12 mg/kg per d) are associated with improvements in agitation in some patients with dementia.
  • At the same time, similar valproic acid levels produced no significant behavioral improvements in most placebo-controlled studies and led to substantial side effects in some patients.
  • Considerable trial design differences exist between controlled and uncontrolled trials.

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