Hepatic Failure from Valproic Acid

To the Editor: We read with interest the recent case report concerning acute hepatic failure in children taking sodium valproate¹ and agree with Temple et al.² that case reports are essential to defining the toxicity of newly marketed drugs. We noted unexpected valproate-related adverse effects on the central nervous system during a pharmacokinetic study of six normal adult volunteers. These effects are of interest because of the widespread notion that sedation and mental changes are rarely seen in patients given this drug.The packaged instructions for valproate use state that adverse reactions cannot usually be ascribed to valproate alone because . . .