1. Gastrointestinal distress (nausea and vomiting) is the most common side effect and often improves with co-administration of food or with switching to an enteric coated preparation such as Depakote.
2. Sedation is common and usually abates in the first few weeks. Hepatitis and pancreatitis are rare complications and usually occur during the first several months.
3. Mild elevations of liver function occur in many patients and require no special treatment except frequent monitoring of liver enzymes.
4. Thrombocytopenia is rare and may require discontinuation of the drug if levels drop below 100,000.
5. Elevation of serum ammonia is a rare complication and is often benign. It may, however, be an indicator of severe hepatotoxicity, especially if accompanied by mental confusion.
6. Valproate is more benign in overdose than lithium or carbamazepine.
F. Pretreatment Evaluation. Physical exam, CBC, platelets, liver function tests, PT/PTT.
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