Valproic Acid in Dementia
Journal of Pharmacy Practice, 04/30/2012  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.