Anticonvulsant, mood stabilizer
Increases brain GABA levels by inhibiting GABA transaminase and enhancing GABA synthesis, modulates sodium and calcium channels, stabilizing neuronal membranes and mood
Epilepsy, bipolar disorder (acute mania), migraine prophylaxis
Status epilepticus, mixed and rapid-cycling bipolar disorder, catatonia (second-line), agitation and aggression in traumatic brain injury (TBI), agitation and aggression in neurodevelopmental disabilities, post-stroke aggression, agitation and psychosis in dementia
Oral delayed-release and extended-release tablets/capsules, liquid formulation, intravenous formulation
250–500 mg p.o. nightly or twice daily, titrated based on serum levels and clinical response
Serum levels 50–125 mcg/mL (mood stabilization)
Hepatic metabolism via glucuronidation; half-life 9–16 hours; protein binding approximately 90%
Sedation, tremor, weight gain, nausea, alopecia, dizziness, gastrointestinal upset
Hepatotoxicity, pancreatitis, thrombocytopenia, teratogenicity (neural tube defects)
Monitor valproate serum levels, complete blood count (CBC), liver function tests (LFTs), and weight every 3–6 months or sooner with dose changes
Hepatotoxicity, teratogenicity, pancreatitis
Valproate is effective as a mood stabilizer in patients with seizure disorders but requires careful monitoring for drug interactions when combined with other antiseizure agents. It may help control aggression and disinhibition in traumatic brain injury (TBI), impulse control disorders in neurodegenerative conditions (particularly frontotemporal dementia), and behavioral dysregulation in individuals with developmental disabilities. Due to its significant teratogenic risk, it should be used cautiously in women of childbearing potential, with alternative mood stabilizers considered when appropriate.